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Physical therapists (PTs) have tended to be largely left out of opportunities to provide telehealth services through Medicare, but that could change significantly if federal lawmakers support APTA-supported legislation recently introduced in the US Congress.

This week, legislators on Capitol Hill announced the introduction of companion bills in the US Senate and House of Representatives that could open the doors to wider use of telehealth in Medicare, including use by PTs. Known as the "CONNECT for Health Act of 2019" (CONNECT), the bills now in the House (HR 4932) and Senate (S 2741) would remove many current restrictions on telehealth in Medicare and give the Secretary of Health and Human Services (HHS) broad authority to waive others. The legislation was introduced by members of the Senate and House telehealth caucuses, with Sen Brian Schatz (D-HI) and Rep Mike Thompson (D-CA) leading the efforts in their respective chambers.

While the bill covers a lot of ground, it's the provisions allowing the HHS Secretary waiver power that should be of particular interest to PTs, according to Baruch Humble, APTA senior specialist for congressional affairs.

"If this bill is successful, starting on January 1, 2021, the HHS Secretary could waive telehealth restrictions and open up opportunities for therapists to be reimbursed for telehealth services as long as those services don't limit or deny coverage and can reduce spending without sacrificing quality of care," Humble said. " That's a big step forward for Medicare."

Baruch added that the waiver rules even have exceptions—namely, that even if a service doesn't reduce spending and maintain quality, a waiver could still be granted if the service was targeted at a high-need health professional shortage area. The waiver process would also be subject to an annual public comment process, and include regular data collection and reviews of waivers conducted no more frequently than every 3 years.

The CONNECT Act includes another potential opportunity for PTs to participate in telehealth by way of programs created through the Center for Medicare and Medicare Innovation (CMMI).

Provisions in the bill would direct CMMI to identify services that could deliver both outcome- and cost-effectiveness through telehealth. Physical therapy is among the services that could be reviewed by CMMI, which could design and test delivery models that could be adopted by Medicare, Medicaid, or the Children's Health Insurance Program.

According to a summary created by the bills' sponsors, current Medicare restrictions that limit telehealth to certain rural areas, clinical sites, and types of providers create "barriers" to a service delivery method that "increases access to care in areas with workforce shortages and for individuals who have barriers to accessing care."

The legislation is endorsed by more than 120 organizations, including AARP, the American Medical Association, and Kaiser Permanente. APTA not only endorsed the legislation but worked in collaboration with the American Occupational Therapy Association and the American Speech-Language-Hearing Association to advocate for their respective professions as the legislation was being drafted.

"The CONNECT act is a win for the profession, not just because it opens the opportunity for telehealth by PTs beginning as early as 2021, but because it establishes a way for the profession to demonstrate, through data and outcomes, how a PT's use of telehealth could make a very real contribution to improved health," Humble said. "PTs using telehealth can play an important role on several health care fronts, particularly in terms of efforts to combat the opioid epidemic by reaching rural and underserved communities with nonpharmacological options to chronic pain."

APTA government affairs staff will continue to track the progress of the legislation. Stay tuned for opportunities to advocate in support of the bills.

APTA offers a summary of research on telerehabilitation's effectiveness and a collection of PT testimonials supporting the use of telehealth. The legislation is just one of several bills and issues APTA is advocating on during this session of the US Congress, which includes APTA-supported legislation aimed at addressing administrative burden and prior authorization (HR 3107), PT student loan debt (HR 2802/S. 970), home health payment issues (S 433 / HR 2573), the Medicare fee schedule, self-referral, and more.

Senate sponsors of the CONNECT Health Act, led by Sen Brian Schatz (HI, at microphone) have introduced a bill that could provide opportunities for greater use of telehealth by PTs.

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