After steering toward a change that threatened to significantly increase the administrative burden faced by PTs, commercial insurer UnitedHealthcare has reversed course on the most problematic elements of its expanded policies. While not specifically citing reasons for the change, the payer won't be requiring additional signoffs for PT services after all.
The most troubling provision of the planned change — essentially an expansion of existing requirements — involved additional signoffs around plans of care. While a plan of care for PT services has always been required by UHC, under the policy expansion, a referring provider or appropriate specialist would have been required to sign and date the plan — a significant administrative hoop for PTs, and a requirement that could potentially delay timely care. APTA expressed its concerns to the insurer.
In the end, UHC backed off on the plan of care signoff requirement, which it adopted in April. Under the change set to take effect Aug. 1, the initial authorization for therapy must also include a plan that identifies functional impairment, short- and long-term therapeutic goals related to the patient's specific functional skills, and anticipated timelines. However, no additional signoffs are needed.
While the most burdensome requirement is now off the books, UHC did hold on to another, less burdensome provision — that PTs must document start and stop times for each follow-up treatment session. The finalized amended policies were shared in a July 10 addendum published by UHC.
"We are pleased that UnitedHealthcare made this decision," said Wanda Evans, PT, DPT, MHS, APTA senior health policy and payment specialist who led the communications efforts with UHC. "These kinds of wins for physical therapy underscore the importance of helping commercial payers understand the real-world effects of potential policy changes on patients and providers."