Message from APTA CT regarding COVID 19

3.27.2020

3/27/20

 

Good morning, 

 

We recognize that COVID-19 continues to rapidly change healthcare but also we are sensitive to how rapidly it is changing the acute care setting.   APTA released resources specifically for Acute Hospital Setting Guidelines.  In support of all physical therapy services within the state of Connecticut, we wanted to cascade those guidelines as quickly and as effectively as possible.  We do know that the situations are ever evolving and continue to recommend checking the CDC guidelines and with APTA for the most up to date information.

 

The summary of the APTA Guidelines can be located at the following link and some of the key components are summarized as:

 

http://www.apta.org/PTinMotion/News/2020/03/26/AcuteHospitalCOVIDGuidelines/ 

 

  • Facilities should consider organizing separate teams to manage COVID-19 versus noninfectious patients.
  • PTs who are practicing within the ICU should have specialized knowledge of working in that setting, while other PTs in the facility who have ICU experience but aren't currently working in the ICU, as well as PTs without recent cardiorespiratory experience, should be facilitating rehabilitation and discharge planning for non-ICU/non-COVID-19 patients.
  • PTs with "advanced" ICU skills should be supported to screen patients with COVID-19, with some being identified as "clinical leaders."
  • Staff who are pregnant should avoid exposure to COVID-19.
  • Physical therapist examination and interventions should be provided only when there are clinical indications for need such as “mobilisation, exercise and rehabilitation e.g. in patients with comorbidities creating significant functional decline and/or (at risk) for ICU acquired weakness” with guideline authors writing that "unnecessary review of patients with COVID-19 within their isolation room/areas will also have a negative impact on PPE supplies."
  • If aerosol generating procedures (AGPs) are required, they should be conducted in a negative-pressure room, or at least in a single room with the door closed, with a minimum number of staff, all wearing PPE. Coming and going should be minimized during the AGP.
  • PTs should not implement AGPs, including humidification or noninvasive ventilation, without first obtaining agreement with a "senior doctor."
  • PTs should take droplet and airborne precautions, including the use of a high filtration mask, when providing mobilization exercise and there is a risk of the patient coughing or expectorating mucous.
  • Direct physical therapist interventions should be considered only when there are "significant functional limitations (e.g. [risk for] ICU-acquired weakness, frailty, multiple comorbidities, advanced age)" in the patient.
  • Staff should be trained in donning and doffing PPE, including N95 fit-checking.
  • For COVID-19 infected patients who may require AGPs, airborne precautions should be followed that include an N95/P2 mask, fluid-resistant long-sleeve gown, goggles/face shield, and gloves. The guidelines also recommend hair cover and shoes that are impermeable to liquids. 

 

For the full 28 page compiled document please see: 

 

http://www.apta.org/uploadedFiles/APTAorg/News_and_Publications/Latest_News/News_Items/2020/Physiotherapy_Guideline_COVID-19.pdf           

 

If you have any questions, concerns, or barriers that arise in the acute care settings please reach out to myself or any of the board members and we will facilitate a swift response. 

 

                                                                                    Thank you and continue to be safe,           

 

                                                                                    Stefanie Bourassa, DPT, MSPT, CSCS

 

                                                                                    President, APTA CT


 

 

 

3/25/20

First, I want to commend you all for your due diligence in protecting the health and safety of the communities in which we serve. Any decisions that are being made by individuals, companies, practices, and leadership are being made with tremendous consideration, reflection, and with utilizing any and all resources available. The conversations about whether or not to stay open, whether or not to enter homes and whether or not to enter facilities, are all incredibly tough conversations and even harder decisions; it is the stance of both APTA and APTA CT that we will support you through this process in any way we can. 

 

Today’s message is about the emergency regulations that have been put in place to facilitate care during this outbreak. The Governor has issued several Executive Orders and other guidance regarding both general licensure and Telehealth. 

 

These can be found on our website, by clicking here or pasting https://www.ctpt.org/Practice/Covid-19/ into your browser. 

 

Most of the guidance thus far has been to make providing care through Telehealth easier. If you are considering implementing Telehealth, it is recommended that you check with 3rd party payers to see what, if any, payment you’ll receive for these services. The Governor’s orders relax some of the standards for delivery, but do not mandate payment for services. We continue to make the case that mandating payment for these services would support Governor Lamont’s “Stay at Home” orders.  

 

In the meantime, in order to ask the right questions to get the paid for your services, we suggest the following questions when contacting insurance carriers: 

 

Will services provided by physical therapists (and PTAs working under the direction and supervision of the PT) be covered when provided via telehealth? 

 

If so, what codes should be billed and what modifiers are required? 

 

What device(s) or application(s) can be utilized? 

 

What, if any, consents are required? 

 

Are there any special documentation requirements? 

 

Are services limited to patients with an existing relationship or can we see new patients? 

 

Additionally, if telehealth has not been part of your practice, check out the link below, provided by APTA, to help you prepare and make the best decision for you and your patients. https://www.aptahpa.org/page/COVID19#InteractiveAudio 

 

As always, if there are any other ways in which we can support you during this time please do not hesitate to reach out.            

 

Stefanie Bourassa DPT, MSPT, CSCS
President, APTA CT 

 

**A new section on Pulmonary Rehab and Acute Care resources have been added to our Chapter Update section. Free online classes are being offered.

 

 
3/24/20 
Some discussion points that I have had over the last few days are around questions and concerns about being deployed to other areas of healthcare systems to support. I encourage you all to stay positive in light of all of this pandemic. Support your fellow healthcare colleagues in any way that you can. I encourage you to continue to advocate for ways in which physical therapy can support healthcare systems as they become inundated with positive cases of COVID-19.  
Sean Collins, Editor in Chief for Cardiopulmonary PT Journal, is hosting a webinar Wednesday March 25, 2020 at noon on the Pulmonary Exam for the PT. The recording of the webinar will also be available at a later date.  

 

Physical Therapists and Assistants are being redeployed to the emergency departments and urgent cares to help with management of musculoskeletal injuries and are collaborating with providers to help decrease the traffic through ERs and Urgent Cares; limiting those seeking medical services to those that are really need the medical care and/or COVID 19 access points. APTA has resources on how to approach those conversations while being sensitive to pandemic.  

 

I encourage you to continue to advocate for patient access but also to support other healthcare colleagues at this time. The collaborative approach and support is essential to the continued well-being of the healthcare system. We are better together.  
We are in this with you, 
Stefanie Bourassa DPT, MSPT, CSCS                                                                               

President, APTA CT        


 

3/23/20 

As we all struggle with the daily personal and professional challenges of dealing with the spread of Covid-19, the APTA CT is working hard to keep you up to date on the changing regulations, as it impacts the provision of PT. We are also continuing our efforts to expand your ability to offer care to your patients. We have received a number of calls with regard to the Governor’s Executive Orders, so we’ve compiled the following analysis of what’s come out thus far and have included links to the Executive Orders: 

 

Executive Order 7F - Expanded Medicaid Telehealth Coverage

 

This Governor’s order allows the Commissioner of Social Services to waive existing requirements to allow telephone only Telehealth services for this population. 

 

Executive Order 7G - Flexibility for Medicaid Enrolled Providers and In-Network Providers for Commercial Fully Insured Health Insurance to Perform Telehealth Through Additional Methods. 

 

This Governor’s order includes the following:

 

(a) allows telephone only care with Medicaid and/or in network provider with existing relationship, if Telehealth is covered

 

(b) Suspends some requirements for licensure, certification or registration

 

(c) allows for flexibility of communication system with regard to HIPAA

 

(d) provides consumer protection by requiring provider identify if a patient has insurance, prohibits additional billings to patient and and sets cap for uninsured at Medicare rate

 

(e) waives requirement that provider must be at licensed facility in order to initiate a Telehealth session. 

 

Executive Order 7H - "Stay at Home"

 

Physical Therapy offices are included in "essential" businesses that may continue to operate in the Department of Economic and Community Development guidance on the order, issued on March 22nd. 

 

The APTA CT continues to work to encourage the Governor and his administration to support Telehealth for physical therapy even in situations where it isn’t currently part of an insurance plan.   It would be consistent with the Governor’s "Stay at Home" order to encourage Telehealth visits, instead of in office visits. Of course every PT wants to see patients in person, but in these difficult times, this flexibility, where it can be effectively utilized, can be part of the solution to flatten the curve. 

 

We are also trying to get answers for challenges that are being raised in a wide variety of practice settings. If you are struggling with these types of questions, please reach out and let us know. 

 

 

 More information to follow with details on how to contact public officials in support of this effort.
 

 

3/20/20  

We recognize that the primary and secondary effects of COVID-19 are rapidly growing throughout our state. There are more and more challenges occurring in regards to staffing, daily operations, access for patients to continued care, and supplies. We continue to work hard to provide you with the resources you need to maintain the safety of our colleagues as well as the safety of our patients and communities. 

 

Last evening we received word that Governor Lamont expanded his executive order on telehealth, and it continues to be a step in the right direction for not only access for physical therapy services to continue for patients, but also expands the abilities for reimbursement for telehealth. 

 

Section 5, Flexibility for Medicaid Enrolled Providers and In-Network Providers for Commercial Fully Insured Health Insurance to Perform Telehealth through additional methods, highlights language that clarifies and allows for the following:

 

  1. Allows for telephone only with Medicaid and/or in network providers with those who have existing relationships; have already started in-person services with the provider
  2. Allows for flexibility of communication with regard to HIPAA
  3. Provides consumer protection for additional billing/back billing, stating that what is approved by the insurance provider is what may be reimbursed and any additional charges that goes beyond the insurance payment cannot be billed to the patient; and sets the cap for uninsured to the Medicare rate
  4. Waives the requirement that the approved provider needs to be at a licensed facility, but must utilize platforms that maintain HIPAA compliance and other telehealth requirements set forth by the commissioner.  

  We will continue to work within our state to further communications and clarifications with insurance providers. We are working diligently with other associations such as the Connecticut Chapter of Occupational Therapy Association, to advocate for continued expansion of access to and reimbursement for telemedicine services. Our colleagues in Massachusetts and Rhode Island are providing us with documentation that assists us in our pursuit of expansion of our services and reimbursement for those services.   

For more information regarding establishing telehealth capabilities for practices, we encourage you to use the resources available through:  

 

The most recent updates from the APTA, at the time of this document being written, include the following:  
1) The American Health Care Association and National Center for Assisted Living, released a joint document regarding change recommendations for PT, OT and SLP to assist with flattening the curve and promoting social distancing. They recommend that long term care facilities discontinue group and concurrent therapy, and delivery therapy within the resident rooms rather than within therapy gyms. They also went on to discourage therapists moving from one building to another building especially if COVID-19 is found to be in one building.  

 

2) Aetna expands Telehealth and Remote Visit Coverage, allows PTs to bill for E-visits. Aetna announced that it would require no co-pay on telemedicine visits for any reason for 90 days and would allow PTs to bill for e-visits consistent with the E-visit waiver policy announced by CMS. This policy is also retroactive to March 9th. The Aetna E-visit approach does allow for PTs to bill for either codes associated with evaluation and management (98970, 98971, 98972) and/or for assessment and management (G2061, G062, and G2063); CMS currently only allows for PTs to bill for G codes. We encourage providers to check with Aetna’s provider page for updates and changes.  

 

3) APTA regulatory Affairs expert will provide a Facebook live event today, March 20th at 2 pm for more information on the e-visit waivers and the CMS announcements. It is open for both members and non-members but there are limited spots available. The event will be recorded and repeated in a webinar.  
We also continue to advocate for our profession to help within emergency rooms and as resources for physical therapy services across different settings; for redeployment else where and to help alleviate the pressures felt by health care providers.    
It is during times like these that I am finding and hearing amazing stories about our profession coming together, working together, supporting each other and advocating for changes that will be impactful on our future. During moments of chaos and adversity comes opportunities for professions to get stronger and come together. Adversity doesn’t break teams, it builds them. Thank you for being our members. Thank you for continuing to advocate for your patients and their continued needs for care. Thank you for continuing to support each other, check on each other and communicate with each other. For those who can, please share with non-members what your association is doing for them both at the state and at the national level.   
Please continue to reach out with anything that we can help you with. Your association continues to be in this with you. We want to hear from you on how we can help, where we can be better, where you need support. It is during times like these that we choose to look for the silver linings and be thankful.   
The American Physical Therapy Association of Connecticut is looking to put on a virtual pub night in the near future! So please follow us on social media, check our website www.ctpt.org and feel free to reach out.  

 

                                               Thank you everyone! Stay safe and healthy.            

 

                                                           Stefanie Bourassa DPT, MSPT, CSCS 
                                                                                   President, APTA CT

 

 3/17/20

 

We recognize that this pandemic is rapidly evolving and changing and we are working hard to provide you all with the most up-to-date and accurate information. We continue to work with our national association, regional associations and state officials to provide you with the best resources to keep you and your patients safe. 

 

In the state of Connecticut, Physical Therapists are recognized as providers of Telehealth, under general statute 19a section 906 and is payable when deemed appropriate by the commissioner under medicaid guidelines. We have been working through our lobbyist team to provide information and justification for Telehealth services to be implemented in this state of emergency and to provide reimbursable skilled physical therapy. In recognizing that patients need continuity of care and access, and that platforms exist that are compliant with HIPPA standards and standards set in place by this general statute, we are working with state legislation to encourage insurances to pay for these services rendered and to maintain the safety and integrity of patients and physical therapy providers.  

 

Yesterday, a letter template was released by the American Physical Therapy Association for advocacy at the national level to recognize and support physical therapy services under this same premise of telehealth. http://www.apta.org/TakeAction/ Now, more than ever, our voices need to be heard in advocacy for our patients and our profession. It is during these health crises that we can work together and unify our voice for a change in the support of how services are rendered and in recognizing that health and access to care is a priority for all individuals looking to improve their function, recover from surgeries, and improve their quality of life. 

 

At this time, because we are health care providers, there has been no requirement or recommendations for physical therapy practices to close. Of course, I encourage you to follow the CDC and the state recommendations.  Please see the resources on our website. I encourage you to take action through the APTA action center. And as always, if there is information or questions please feel free to connect with myself or any of the Board of Directors. Please check social media and our website often. I will try to continue to communicate consistently throughout this challenging time. Stay safe and healthy!
Sincerely,
Stefanie Bourassa DPT, MSPT
President APTA CT

 


 

3/12/20

We recognize that the current health care state is in a heightened awareness and standard precautions are requiring daily changes in operations and prevention of the spread of COVID-19.  APTA CT leadership components are working with state officials and our national chapter to provide up to date information in regards to CDC guidelines, disease prevention gold standards, and maintaining a trusted relationship with our communities in which we serve and our membership. 

In light of COVID-19 and CDC guidelines, and recognizing your own operational changes and recommendations based off of your setting, APTA CT is encouraging all members, committees and special interest groups to move all meetings, continuing education opportunities, and gatherings to a virtual platform if possible, or be rescheduled to a future date with the recommendations of preparing those dates to be after April 20th.  

We recognize that this is an evolving process and that there is continued questions and concerns, we encourage you to reach out to the board of directors and executive team with any of those questions and we can help facilitate responses and/or resources as needed. 

Thank you for your commitment to maintaining a health and safe environment for all within our physical therapy community!


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