Yesterday CMS expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the COVID-19 Public Health Emergency. CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. More information: https://www.cms.
gov/newsroom/press-releases/ trump-administration-drives- telehealth-services-medicaid- and-medicare
Updated October 27, 2020
The PPS COVID-19 State of Affairs document is updated weekly to help you keep abreast of the most recent legislative and regulatory updates. Here are some important notes this week:
On October 22nd, the U.S. Department of Health and Human Services (HHS) again updated the Provider Relief Fund (PRF) reporting guidance and materials. These guidelines build off of the 2-page framework released on July 20, 2020. The reporting portal is set to open Jan. 15, with the first reporting deadline scheduled for Feb. 15. See additional details on p. 10 of the State of Affairs.
HHS' Office of Inspector General announced plans in October to study and evaluate the use of Medicare Telehealth Services during the COVID-19 Pandemic. The planned release date is sometime in 2021.
HHS Allocates $20B of Provider Relief Fund to Multiple Provider Categories
Today, the Department of Health and Human Services (HHS) announced $20 billion in new funding for providers on the frontlines of the coronavirus pandemic through Phase 3 General Distribution allocation. HHS stated that providers who received Provider Relief Fund payments can apply for additional funding, as well as previously ineligible providers, such as “those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.”
HHS stated that the new Phase 3 General Distribution is “designed to balance an equitable payment of 2 percent of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.” HHS Secretary Alex Azar stated, “HHS has worked to ensure that all American healthcare providers receive support from the Provider Relief Fund in a fast and fairway, and this new round helps ensure that we are reaching America’s essential behavioral health providers and takes into account losses and expenses relating to coronavirus.”
Additional Details on Eligibility – HHS states that it is “making a large number of providers eligible for Phase 3 General Distribution funding, including:
• Providers who previously received rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
• Behavioral Health providers, including those that previously received funding and new providers.
• Healthcare providers that began practicing January 1, 2020, through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers.”
Providers may apply for funding from October 5, 2020, through November 6, 2020.
The Private Practice Section introduces the 2020 slate of candidates for your consideration. After a careful review, we believe the individuals slated possess the background, talent, and character needed to achieve the goals established in the strategic plan and to carry out the mission of the Section. Absentee voting online will open September 28. The candidates will be formally presented to the membership during the PPS Member Business Meeting, October 28, 2020, and voting will conclude October 30, at 3:00 pm EDT.
We urge all members to participate in this election.
As I am sure you have heard on the news, on Friday 12/14, a federal judge in a lower court in TX filed a decision that declared the Affordable Care Act to be unconstitutional. His decision hinged on the fact that last December's tax bill the fine for not obtaining health insurance was reduced to zero. The decision held that since that fine has bee reduced to zero, that "tax" has been functionally removed from the law.
The reason this argument matters is that when the Supreme Court evaluated the constitutionality of the ACA previously, it determined that in fact the government did have the authority to compel Americans to have health insurance coverage, citing the Constitution granting Congress the authority to tax and spend. In yesterday's decision, the judge determined that since the "tax" has been reduced to zero, that authority has been relinquished and therefore the whole law must be struck (because of the argument that the taxing authority granted to Congress was the sole reason that it was able to compel Americans to have health insurance--and that the existence of the entire law hinged upon the taxing authority).
The ruling will not impact the 2019 health insurance plans sold through the exchange/marketplace of healthcare.gov or the state equivalents. It also won't immediately affect Americans' health coverage. The most immediate impact could be upon whether or not states will continue to consider expanding Medicaid at a time when the effort might be for naught.
An appeal is inevitable and already being discussed by a group of states led by California. They are likely to argue that the amount of the fine is immaterial, and that the $0 amount is not the equivalent of repealing the tax/fine and that the law still contains (and has the authority to impose) a fine. Because of the high stakes, and the political aspect of the law, the appeal process is likely to make its way to the US Supreme Court. This will take time.
If the US Supreme Court upholds the argument that the entire Congressional authority hinges on whether or not there is a tax/fine of more than $0 imposed upon those who do not have health insurance coverage, then the entire law will be invalidated. If that is the case, Americans will lose pre-existing condition protections, the ability of folks to stay on their parents' health insurance up to age 26 and other provisions of the ACA that have recently become popular on both sides of the aisle and the preservation of which has been a PPS legislative priority.
In a closely watched case, Judge Reed O’Connor of the Federal District Court in Fort Worth, Texas ruled that the Affordable Care Act's individual mandate, which Republicans zeroed out with their tax bill, “can no longer be sustained as an exercise of Congress’s tax power.” And the rest of the law cannot be separated from that provision and is therefore invalid, he wrote.
The New York Times: Texas Judge Strikes Down Obama’s Affordable Care Act As Unconstitutional
A federal judge in Texas struck down the entire Affordable Care Act on Friday on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it. The ruling was over a lawsuit filed this year by a group of Republican governors and state attorneys general. A group of intervening states led by Democrats promised to appeal the decision, which will most likely not have any immediate effect. (Goodnough and Pear, 12/14)
The Associated Press: Federal Judge Rules Health Care Overhaul Unconstitutional
In a 55-page opinion, U.S. District Judge Reed O’Connor ruled that last year’s tax cut bill knocked the constitutional foundation from under “Obamacare” by eliminating a penalty for not having coverage. The rest of the law cannot be separated from that provision and is therefore invalid, he wrote. Supporters of the law immediately said they would appeal. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans,” said California Attorney General Xavier Becerra, who is leading a coalition of states defending the ACA. (Alonso-Zaldivar, 12/14)
Politico: Judge Rules Obamacare Unconstitutional, Endangering Coverage For 20 Million
“In some ways, the question before the Court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote. “The former enacted the ACA. The latter sawed off the last leg it stood on.” (Demko and Cancryn, 12/14)
Texas Tribune: Federal Judge Rules Obamacare Unconstitutional, Handing Texas An Early Win
In a ruling that could throw the nation’s health care system into chaos, Fort Worth-based U.S. District Judge Reed O’Connor on Friday ruled that a major provision of the Affordable Care Act is unconstitutional — and that the rest of the landmark law must fall as well. In February, a Texas-led coalition of 20 states sued the federal government to end the health care law in its entirety, arguing that after Congress in December 2017 gutted one of its major provisions, the rest of the law was unconstitutional. (Platoff, 12/14)
Kaiser Health News: Judge Strikes Down ACA Putting Law In Legal Peril — Again
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015. (Rovner, 12/14)
PPS’ legislative priorities call for us to address and mitigate the negative effects associated with physician self-referral. In August, PPS filed formal comments in response to CMS’ RFI on physician self-referral. On October 26th, PPS filed formal comments with the Department of Health and Human Services’ Office of Inspector General urging both limits to the use of beneficiary incentives as well as transparency if providers are offering incentives to retain or induce patients to choose a particular provider. In both comments, PSS urged the prompt removal of PT from the IOASE and requesting increased accountability and transparency for referrals made utilizing the IOASE.
Each fall, PPS members exercise their voting rights by electing new leadership to serve the Private Practice Section, APTA. This year, online voting began on October 5th and will close November 2nd. Those who are present at the PPS Annual Conference and Exhibition in Colorado Springs will be given the opportunity to vote onsite at the PPS booth November 8-9th. All PT and PTA members are eligible to vote.
CANDIDATE SLATE AND CANDIDATE STATEMENTS
The 2018 Slate of Candidates is shown below. Each candidate was unanimously approved by the PPS Nominating Committee and Board of Directors. PPS believes that each of these individuals will uphold the mission of the Section, and that they possess the background, talent, adn character required to acheive the goals established in the PPS strategic plan.
Click on each candidate's name to view their candidate statement. *Candidates are listed in reverse-alphabetical order
Treasurer (1 Position Open)
Secretary (1 Position Open)
Director (2 Positions Open)
Nominating Committee (1 Position Open)
The PPS Administrators' Network was formerly known as the PPS Administrators Council. All members of the PPS Administrators Council have retained their active membership status and login credentials with the Administrators' Network and need not reapply.
PPS is more than a network of PTs, PTAs, and students. Every physical therapy clinic is home to at least one administrator who serves as the first point-of-contact for patients, oversees marketing, ensures compliance and proper coding, and more. PPS has a built a home for these invaluable staff with the PPS Administrators’ Network. Give your administrators and office managers the resources, education, and networking opportunities they need to serve your practice best by giving them a membership to the PPS Administrators' Network. Give your administrators and office managers the resources, education, and networking opportunities they need to serve your practice best by giving them access to the PPS Administrators' Network.
What are the Benefits?
ACCESS TO THE CERTIFIED ADMINISTRATOR PROGRAM Administrators who complete and pass the Administrators' Certification coursework are proficient in Billing & Coding, Legal Compliance, Human Resources, Business Operations, Marketing, Customer Service, and Financial Management.
After successful completion of 12 hours of coursework covering the above topics, students are tested on their knowledge and, if they pass, will be recognized as a PPS Certified Administrator. The certification coursework is available at PPS Annual Conference.
FREE QUARTERLY WEBINARS Designed to keep administrators up-to-date on the latest billing and coding information, compliance issues, marketing trends, and other relevant topics.
PEER NETWORKING OPPORTUNITIES As a PPS member, you understand the value of peer networking, collaboration, and mentorship. Administrators' Network members enjoy the same benefits through in-person networking events, an exclusive online community, and membership directory.
LEADERSHIP DEVELOPMENT All Administrators are encouraged to participate in the development of the Network and its strategic initiatives through volunteer participation in committees and task forces.
FULL ACCESS TO PPS MEMBER RESOURCES Administrators' Network members receive the same discounts on educational conferences and materials as PPS members, they gain full-member access to the PPS website, and their own subscription to Impact Magazine where they can read articles written by their colleagues in Impact's Administrators Edge Column.
Who is Eligible?
The Administrators' Network welcomes all non-PT office managers and administrators employed by PPS members to be a part of the largest network of physical therapy clinic administrators in the country!
PPS has developed multiple educational video series to ensure that every PPS member has fundamental business management knowledge in Marketing, Finance, and Operations. The courses below can be accessed at anytime in the PPS Learning Center and are free to PPS members
In this 5-module, video series, learn how to define your target audience and develop a brand promise that engages customers. Discover marketing best practices, and tools to develop your marketing plan and accompanying budget. Finally, take a deep dive into three marketing strategies proven effective in marketing a physical therapy practice.
- Module 1: Defining your target audience & developing a brand promise
- Module 2: Developing a marketing plan and budget
- Module 3: Referral source marketing
- Module 4: Internal marketing
- Module 5: Consumer/community outreach & marketing
Operations 101 provides an introduction to Key Performance Indicators and outlines the standardized definitions of recommended KPI's used to manage physical therapy practices. In modules two and three of this 3-part series, participants will learn how to use data and metrics to successfully manage practice operations, and will develop a strategy to create successful KPI performance.
- Module 1: Introduction to Key Performance Indicators (KPI's)
- Module 2: Using KPI's in your Physical Therapy Practice
- Module 3: Management and Impact of KPI's on Your Practice
Finance 101 is a free, multi-module, video series that provides a solid foundation for those managing the finances of a physical therapy practice. The series was designed for non-financial people to gain improved understanding of bookkeeping methods, financial statements, and key terms requisite to successfully managing the finances of a physical therapy practice.
- Module 1: Setting the Stage: Introducing key financial terms and concepts
- Module 2: Finance for Non-Financial People
- Module 3: Financial Statements
- Module 4: Using Finance in Your Practice
- Module 5: Bringing it All Together
- Module 6: Real Life Questions
- Module 7: How To and Tools
Three years after being elected President of the American Physical Therapy Association, Sharon L. Dunn, PT, PhD, stood before the House of Delegates and delivered an invigorating address to the body of electorates who first voted her into leadership back in 2015. At the heart of her message was a repeated and compelling charge to act as she emphasized that it is not enough to call out inadequacies in the system, or to idly tweet about embracing change or promoting inclusion. No, she reiterated that as a profession we must band together and work collaboratively to secure the future of our profession.
“The members of the American Physical Therapy Association were bold enough to dream of transforming society,” she reminded, “Now we must deliver on that promise by following the most universal piece of advice we provide to our patients and clients: we must move!”
Memorable Quotes from President Dunn’s speech are highlighted below:
SETTING A NEW TONE FOR THE FUTURE
“Most of us in this room wear those battle scars—and quite proudly. But where our past was shaped with sharp elbows, our future must be shaped with open arms. Where our origins situated our profession in recovery and the treatment of disorder, our future will be characterized by an increased role in sustaining health and proactively preventing disability and disease. And where previously we have demanded respect in part by staking out turf and occasionally pointing to the shortcomings of others, in our future we will demonstrate our value based on the irrefutable data of our own outcomes and in partnership with our colleagues across disciplines. The health care system and our patients will demand nothing less."
QUESTING OVER RESTING
“We should approach our future with enthusiasm, not dread, because our profession has never been satisfied with our position within the status quo. Our existence has been one of almost constant self-challenging evolution. Our progress has never been inevitable; it has always been hard-earned. So if we truly desire to not only see society transformed but to shape that transformation, we must not only weather the storm of health care disruption. Instead, as Dr Alan Jette urged in his 2012 Mary McMillan Lecture, we must face into the storm and choose questing over resting.
WE MUST BE AGENTS, NOT CRITICS
"We cannot transform society through judgment. Our vision charges us not to stand at a distance and point our fingers at our nation's ills but instead to accept a personal responsibility to try to make a difference.
"At our core, we are healers, and as much as ever our country and our society need healing. It is not enough that we tweet about it in judgment. It is not enough that we adopt policies that articulate our principles. It is not enough that we sit idly by, in the comforts that were afforded by those who forged the path before us.
LET NO ONE FEEL LIKE AN OUTSIDER
"To fulfill our mission, our community must vastly improve our diversity by being intentional about inclusion. We must prioritize listening and learning. We must enable the next generation of physical therapists and physical therapist assistants to transform our association, just as our association must transform society. Most of all we must get involved—with open arms and open minds—not only as a community, but as individuals."
OUR MOST VALUABLE ASSET: AN ENGAGED MEMBER
"When we formally charge APTA to act, or simply daydream about "what APTA should do...," we sometimes behave as if we're writing a check for someone else to cash. But as an individual membership association, we are charging ourselves-we are writing our own to-do list. APTA is not a distant factory that churns out ready-to-order physical therapy progress on a conveyor belt. It's a community of physical therapists, physical therapist assistants, and students. It's our community. We are APTA, and APTA is us. Our association's growth, commitment, and determination cannot outpace our own personal development."
FOLLOW OUR DREAMS WITH OUR OWN FOOTSTEPS
"If, like I do, you anticipate a day when physical therapists, like dentists, are part of our society's regular health routines, don't just point the way—raise a hand and accept a portion of responsibility to take us there.
APTA President Sharon L. Dunn, PT, PhD, Board-Certified Orthopaedic Clinical Specialist, was reelected to a second 3-year term, June 25, 2018. To read the full transcript of her 2018 address, or to watch the video, visit the APTA website.
The monthly toolkit is made up of free, ready-to-Share, professionally written, content for marketing your physical therapy practice to your community. We have monthly newsletters/blog posts, social media posts, and press release templates that can be copied and pasted, or customized to your practice with some simple edits. This month's theme, "Promoting the Annual PT Exam," encourages readers to schedule an annual PT exam with their family physical therapist. You are encouraged to take advantage of the newsletter, press release, and social media posts, in your own promotions of the annual PT exam.
If you have questions about how to incorporate a press release into your marketing plan, or how best to use the press release template provided each month by PPS, refer to this article by Michelle Collie, PT, DPT, MS: "Press Releases: Your Top Six Questions Answered."
In an effort to showcase our profession within the health care community and the impact PTs and PTAs have on the public at-large, APTA and the Private Practice Section of the American Physical Therapy Association (PPS) hosted a video contest in 2017. Physical Therapists were challenged to develop a piece of creative that challenged payors to acknowledge that physical therapy is the most cost-efficient, non-invasive, and speedy way to improve a patient's long-term condition. Contest participants were asked to highlight three key points in their videos:
- Physical Therapy Transforms Society
- Physical Therapy Reduces Health Care Costs
- Physical Therapy Improves Patient Outcomes
First Place: "Get PT 1st" by Sports Physical Therapy
Second Place: "Physical Therapy" by Sarton Physical Therapy