In a letter to Congress, the association urges lawmakers to craft a COVID-19 relief package that not only provides emergency relief but improves care after the emergency ends.
As Congress debates the contents of a fourth COVID-19 relief package, APTA is urging lawmakers to look at both short- and long-term solutions — for instance, not just providing hazard pay for PTs on the front lines of the crisis and temporary help for private rehab clinics, but making permanent changes that would allow PTs to participate in telehealth and expand a PT's ability to bring in a substitute when needed.
And APTA advocates for mid-term solutions as well: specifically, suspension of a CMS plan to dramatically reduce payment for physical therapy and host of other health care services beginning in 2021.
The recommendations from APTA are spelled out in a letter to both houses of Congress that outlines seven steps lawmakers should take to "ensure patient safety and to protect health care providers." APTA is urging members to join in a grassroots effort to press for adoption of the policies.
"What APTA is providing to Congress is a set of common-sense provisions that keep patient access to care front-and-center — not just in the midst of this emergency but for the recovery period and long after," said Justin Elliott, APTA's vice president of government affairs.
Elliott adds that a number of the association's suggestions have already been fleshed out and could be more easily incorporated into the relief package.
"Many of our recommendations are included in already-existing bipartisan legislation, which means that they're familiar to many lawmakers," Elliott said. "Congress won't have to take time crafting these changes; they can just incorporate these bills into the larger relief package."
The association's recommendations include:
Suspension of planned CMS cuts in 2021. CMS is still moving forward with a plan to reduce reimbursement for codes that affect payment for more than three dozen health professions, including physical therapy, which is facing an estimated 8% cut. CMS says that due to budget neutrality requirements, the cuts have to be made to pay for increases it wants to make to evaluation and management codes for physicians. APTA's suggestion: include the legislative language provided to Congress by APTA that would waive budget neutrality for at least five years so that CMS can provide the increases without sacrificing payment to other professions and risking patient access to care.
Approval of "hazard pay" and increase production and access to PPE. APTA writes that "many health care workers … are risking their health and lives every day due to potential exposure to the coronavirus," including PTs and PTAs. Funding hazard pay for these essential health care providers would be particularly helpful, given that many of them could be exempted from receiving expanded sick and family leave if their employer chooses, according to the association. APTA acknowledges that providing additional financial support to essential health care providers will not reduce risk of exposure to the virus, which is why the association also urges the federal government to do significantly more to facilitate the timely manufacturing and distribution of ventilators and PPE through a process that is transparent, equitable, based on need, and noncompetitive.
More support for health care providers with small businesses. In its letter, APTA requests that Congress include language from the Immediate Relief for Rural Facilities and Providers Act, a bipartisan bill sponsored by Sens. Michael Bennett and John Barraso, and Reps. Terri Sewell, Phil Roe, and Kim Schrier. The legislation would provide for emergency one-time grants equal to a qualifying health care provider’s business's total payroll during the first quarter of 2019, and create a low-interest loan program.
A permanent resolution of telehealth restrictions on physical therapy. While therapists wait for HHS to act on its new authority via the CARES Act to provide emergency waivers that would temporarily add providers of telehealth during the declared emergency, a long-term and permanent policy solution is needed that would allow physical therapy to be conducted via real-time face-to-face virtual encounters — something CMS currently says PTs and PTAs aren't allowed to do but that APTA is working to change. APTA recommends that Congress include the bipartisan CONNECT for Health Act in any future relief package as a long-term policy solution for telehealth.
Support for IDEA. The association believes "this is not the time to roll back civil rights protections for students with disabilities" through waivers to either the Individuals with Disabilities Education Act or the Rehabilitation Act of 1973.
Expansion of locum tenens. While CMS in 2016 enabled PTs to qualify for payment under Medicare when they bring in a replacement professional during the PT's temporary absence — known as locum tenens — that ability is restricted to outpatient services in a health professional shortage area, a medically underserved areas, or a rural area as defined by HHS. APTA's letter recommends that including the Prevent Interruptions in Physical Therapy Act, which removes the geographic restrictions, "would relieve potential staffing shortages faced by small clinics" in light of the pandemic.
Support for physical therapy in community health centers. APTA points out that as thousands of Americans face "a long and difficult road to recovery," many will rely on community health centers to provide needed care. Currently, PTs aren't among the clinicians allowed to directly bill Medicare and Medicaid for care provided in community health centers, but APTA says they should be. That's a change that could happen with the relief package included the bipartisan Primary Health Services Enhancement Act.
In addition to its advocacy for relief provisions with a particular connection to the physical therapy profession, APTA has also joined with 12 other professional health care organizations to press Congress to shape the next relief package through a range of policy changes. In addition to recommendations around hazard pay, telehealth, and small business support, that letter also urges lawmakers to ensure better access to PPE, increased provider safety, aid for underemployed and unemployed health care providers, and support for rural facilities.