Practice and Research Committee

The Federal Public Health Emergency Ended May 11! 

What This Means For PT Practice

Telehealth changes

From APTA: At the PHE's End, Still No Clarity on Facility-Based Use of Telehealth Please note: This communication, dated May 11, 2023, is the most recent update and provides more information than the other links. The article summarizes the results of a meeting held with HHS on May 11 and urges caution for providers who continue to use telehealth. Specific recommendations in this article include:

• Be flexible with patients but prioritize in-person physical therapy.
• If telehealth is the only way to provide services, consider getting an ABN from the patient.
• Check with your MAC and document their responses.
• Stay informed. Please read the full article for more detailed information. Meantime, APTA will continue to press CMS for answers. 

 From APTA:  For Facilities, What About Telehealth Post-PHE? APTA Presses CMS for Answers

This article references important concerns regarding inconsistencies in rules that would seem to exclude therapists in a range of facility settings from continuing to provide remote care, even as allowances remain in place for those in all other settings.

From APTA: Podcast | End of the Public Health Emergency: What You Need to Know | APTA

From HHS Office for Civil Rights:  Delay for the Return of HIPAA Enforcement: HHS Office for Civil Rights Announces the Expiration of COVID-19 Public Health Emergency HIPAA Notifications of Enforcement Discretion | HHS.gov

Statement from US Department of Health and Human Services, Office of Civil Rights regarding delay of enforcement beyond May 11 for HIPAA Privacy, Security, Breach Notification, and Enforcement Rules (“HIPAA Rules”) promulgated under the Health Insurance Portability and Accountability Act of 19961 (HIPAA“OCR is providing a 90-calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will be in effect beginning on May 12, 2023 and will expire at 11:59 p.m. on August 9, 2023.   OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period.”

The Notice of Expiration of Certain Notifications of Enforcement Discretion Issued in Response to the COVID-19 Nationwide Public Health Emergency may be found at: https://public-inspection.federalregister.gov/2023-07824.pdf - PDF.

Miscellaneous Updates and Projected Changes:

From APTA: The End of the Public Health Emergency: What You Need to Know | APTA

Please note: This article was published March 9, 2023 and has not been updated. For HIPAA update, please refer to the HHS Office for Civil Rights update noted above. For the current concerns regarding provision of telehealth, please reference the article, For Facilities, What About Telehealth Post-PHE? APTA Presses CMS for Answers | APTA.

Also, realize that the PTA supervision requirements for Medicare reimbursement contained in this article do not apply and are superseded by the supervision requirements in the PA Practice Act and Chapter 40 regulations.  The article references information related to Medicaid and CHIP coverage, and the return of the Three-Day (SNFs) and Minimum Hours (IRFs) Rules.

All Pennsylvania Waivers Are Officially Expired!

Pennsylvania PTA Supervision Waiver

The PTA Supervision waiver expired June 20, 2022.

Supervision requirements reverted back to the language in the Practice Act and Chapter 40 regulations!

Pennsylvania Telehealth Waiver Status: 

The Pennsylvania Waiver “Licensed Health Care Practitioners providing Telemedicine Services” officially expired on Oct. 31, 2022.

This does not mean that PTs and PTAs cannot provide services via telehealth!

The PA Department of State published “Frequently Asked Questions” to provide guidance on telehealth as a method of practice.  The following are important excerpts from that link:

• Reaffirms that “…there is no statute in Pennsylvania that explicitly authorizes the use or disallowance of telemedicine in Pennsylvania….” 
• States that when the telemedicine waiver does expire, “it will not affect licensees’ continued use of telemedicine from a professional standpoint.”
• States that “practitioners must practice within the acceptable and prevailing standard of care.  Because the practice acts and regulations do not currently address the provision of health-related services by telehealth/telemedicine, there could be no violation for simply using telehealth/telemedicine after October 31, 2022, and in general, there is nothing that would prohibit licensees from using telehealth/telemedicine so long as doing so complies with the standards of acceptable and prevailing medical practice….” 

Please access the Department of State Telemedicine FAQs (pa.gov) for more specific information. Also, please see the information below, which addresses the Professional Scope of Practice as defined by APTA.

Telehealth as a Method of Practice

The Department of State issued Frequently Asked Questions reaffirming that:

“There is no statute in Pennsylvania that explicitly authorizes the use or disallowance of telemedicine in Pennsylvania…” 

and

“In general there is nothing that would prohibit licensees from using telehealth… so long as doing so complies with the standards of acceptable and prevailing …practice…”

Pennsylvania therapists can find evidence to support the use of telehealth as an acceptable method of physical therapy practice delivery from the Professional Scope of Practice, which APTA defines as “grounded in basic, behavioral, and clinical sciences…supported by education, based on a body of evidence, and linked to existing and emerging practice frameworks. The professional scope of practice evolves in response to innovation, research, collaboration, and changes in societal needs.”

There is a significant amount of information on APTA's Telehealth in Practice website indicating that telehealth is included in the professional scope as a method of practice delivery. There are numerous articles discussing the use of telehealth, and there is also a certificate course for therapists.

Telehealth Reimbursement

Please refer to Payment Specialist updates for current status of Medicare and Commercial Insurer reimbursement for telehealth services..

The Practice & Research Committee will continue to monitor APTA, Pennsylvania.gov and other pertinent websites and will inform you of any new information as it becomes known.

Practice Spotlights

The APTA Pennsylvania Practice & Research Committee "Practice Spotlights," are published as a member benefit. These brief handouts and videos address various clinical topics of interest for PTs, PTAs, and students and will be released periodically. The spotlights will be featured in the weekly APTA Pennsylvania event emails on Tuesday afternoons and available to view on the Practice Spotlight page (please note: member login required).

Practice Updates

Review all COVID-19 updates on the APTA Pennsylvania COVID-19 FAQ & Resource page.

 

 

Committee Members

	Mary Ann Wharton Practice & Research Committee Chair		Pam Pologruto
	Brooke Klatt		Alexis Del Palazzo
	Melissa Myers		Kimberly Wynarczuk
	Tammy Frey, PTA