September 16, 2020

As some of you may know, the CDC and MDHHS has recently updated recommendations for PPE for all healthcare providers regardless of setting. They recommend that all healthcare providers wear eye protection in addition to their facemask to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters when working in facilities located in areas with moderate to substantial community transmission based on the following definitions:

  • Substantial community transmission: Large scale community transmission, including communal settings (e.g., schools, workplaces)
  • Minimal to moderate community transmission: Sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases
  • No to minimal community transmission: Evidence of isolated cases or limited community transmission, case investigations underway; no evidence of exposure in large communal setting

However, terminology for transmission risk is when using the Michigan Safe Start Map (https://www.mistartmap.info/) uses the terms Low, Low-Medium, Medium, Medium-High, High, and Very High. APTA Michigan has received the following clarification from MDHHS: “All of Michigan is either in medium, medium-high, or high risk areas right now (as outlined in the MI Safe Start Map) and considered to have moderate to substantial transmission right now. We are recommending all HCP wear eye protection for patient encounters due to the level of risk of asymptomatic/pre-symptomatic transmission.” There are not specific guidelines for specific types/brands of eye protection (face shield, goggles, safety glasses etc) other than providers should select equipment that minimizes gaps above, below, and on the sides.

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September 11, 2020

APTA Michigan 2020 Election Tentative Slate

Please review the slate of candidates. Elections will start near the end of September.  

President:                                                                             Edward Mathis

Vice-President:                                                                    Scott MacDonald

Speaker of the Membership:                                               Nichole Chakur

                                                                                               Lydia Lytle

                                                                                                  Kathleen Walworth

Director of Communications:                                             Crystal Gluch

Director for Payment:                                                          Christopher Nawrocki

Director of Professional Development:                             Robert Budai

                                                                                               Mihir Trivedi

 

Delegate (2):                                                                        Katelyn Beam

                                                                                              Jennifer Blackwood

                                                                                               Lydia Lytle

                                                                                               Ajay Middha

                                                                                               Sarah Patterson

                                                                                               Michael Shoemaker
 

PTA Caucus Representative:                                               ----  no nominations ---

 

Nominating Committee Member-At-Large:                 Linda Hall

Nominating Committee Northern:                                 Kristin (Mauks) Hoeh

Nominating Committee Western:                                  Kristin VanderArk

                                                                                          Daren Webb

 

Northern District Chair:                                                  Sarah Patterson

 

Western District Chair:                                                      Cameron Faller

 

Eastern District Director (2):                                            Mihir Trivedi

                                                                                            Annette Nickel

 

Eastern District Vice-Chair:                                              Karen Houting

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September 04, 2020

APTA Michigan submitted comments to CMS to address the 9% payment cuts in the 2021 Proposed Physician Fee Schedule.  Download file

We encourage all members to submit comments as well.  APTA provides template letters for PTs, PTAs, and students and patients. Submit letters to CMS here.

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September 03, 2020

APTA Michigan became aware of guidance issued by MDHHS.  It was not clear where this guidance applied.  The question and subsequent answer are provided below:

Question

New guidance from MDHHS includes a requirement to wear Face Shields in addition to masks. See the text and link below – this was updated August 6.

Healthcare personnel working in facilities located in areas of moderate to substantial community transmission should wear eye protection during all patient care encounters.  https://www.michigan.gov/documents/coronavirus/MDHHS_PPE_Optimization_Final_4-1-202_685482_7.pdf

Based on the terminology in the link below, it is not clear who fits in the moderate to substantial category.

https://www.mistartmap.info/

Response from MDHHS

Thank you for contacting MDHHS about coronavirus disease (COVID-19). In response to your question(s), please review the following information. The following guidance applies across the state, but there may be more restrictive or specific guidelines in your area. Please check your local health department website for more information.

The CDC definition of community transmission in Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic determines the category.

  • Substantial community transmission: Large scale community transmission, including communal settings (e.g., schools, workplaces)
  • Minimal to moderate community transmission: Sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases
  • No to minimal community transmission: Evidence of isolated cases or limited community transmission, case investigations underway; no evidence of exposure in large communal setting

All of Michigan is either in medium, medium-high, or high risk areas right now (as outlined in the MI Safe Start Map) and considered to have moderate to sustained transmission right now. We are recommending all HCP wear eye protection for patient encounters due to the level of risk of asymptomatic/pre-symptomatic transmission.

Thank you again for contacting MDHHS. Information around the coronavirus outbreak is changing rapidly. The latest information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.

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September 02, 2020

Congratulations to Bana Odeh who was selected to represent APTA Michigan in the APTA Centennial Scholar Program.  

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September 02, 2020

Join your acute care cardiopulmonary colleagues from around the state for a PAC fundraiser event on September 24 at 8:00PM. Virtual tickets for this $20 Zoom-based PAC social event will be a valuable contribution to the PAC, and will provide a great opportunity to network and get to know others who share your same passion acute care cardiopulmonary physical therapy. The starting question for discussion will be “How has your practice changed since the start of COVID-19?” This clinically-oriented social event is a first for APTA Michigan…please help make it a success!  The discussion will be led by Michael Shoemaker.  

To RSVP/Register for the event, go to https://aptami.org/political-action-committee/ and make a donation of $20 or more.  In the line with your name include the words Event 9/24

An email with a Zoom link will be sent to all who donate and register. 

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August 26, 2020

APTA Michigan met with Priority Health (PH) today. PH stated that they are interested in continuing payment for telehealth-based PT services, however, the payment RATE for telehealth may not remain the same as in-person visits. PH asked APTA MI for data that compares clinical outcomes of primarily telehealth-based episodes of care to in-person episodes of care. They are continuing to consider payment for dry needling in response to information and data we previously provided. APTA MI has requested that PH eliminate the requirement that documentation be submitted for all Medicare Advantage claims beyond $3,000, and a meeting on this topic will be scheduled in the near future. PH will be using a consolidated platform, GuidingCare, for managing clinical information submitted to PH. Lastly, we continued our generative dialogue about alternate payment models. It is clear that progress on payment model reform hinges on our ability to provide clinical outcome data. It is critical that providers begin to participate in clinical outcome registries. We are unable to demonstrate our value without DATA!

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August 21, 2020

APTA Michigan met with BCBSM on August 20 to discuss a variety of issues important to our members and the patients we serve. This was a productive meeting, and we appreciated BCBSM’s transparency and the opportunity to engage in generative dialogue. Several follow-up items were requested by BCBSM, including additional information on direct access and dry needling. The follow-up communications provided by APTA Michigan can be found on our payment resources page HERE.  

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August 13, 2020

https://www.apta.org/contentassets/15ad5dc898a14d02b8257ab1cdb67f46/impact-of-covid-19-on-physical-therapy-profession.pdf

Between April 24 and May 11, 2020, APTA surveyed a representative sample of physical therapists and physical therapist assistants to gauge the impact of the COVID-19 pandemic on the physical therapy profession.

This report is based on responses by more than 5,400 PTs and 1,100 PTAs — members and nonmembers, across practice settings and jurisdictions. The survey findings represent a snapshot in time. It is expected that situations for PTs and PTAs will continue to change according to fluctuations in COVID-19 cases and changes in state and federal guidance.

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July 20, 2020

The IRS recently announced that the CARES Act Provider Relief Funds are considered taxable income. The following is from the HHS provider relief FAQs that were just posted yesterday (July 13).

May a health care provider that receives a payment from the Provider Relief Fund exclude this payment from gross income as a qualified disaster relief payment under section 139 of the Internal Revenue Code (Code)? (Added 7/10/2020)

No. A payment to a business, even if the business is a sole proprietorship, does not qualify as a qualified disaster relief payment under section 139. The payment from the Provider Relief Fund is includible in gross income under section 61 of the Code. For more information, visit the Internal Revenue Services' website at https://www.irs.gov/newsroom/frequently-asked-questions-about-taxation-of-provider-relief-payments

Is a tax-exempt health care provider subject to tax on a payment it receives from the Provider Relief Fund? (Added 7/10/2020)

Generally, no. A health care provider that is described in section 501(c) of the Code generally is exempt from federal income taxation under section 501(a). Nonetheless, a payment received by a tax-exempt health care provider from the Provider Relief Fund may be subject to tax under section 511 if the payment reimburses the provider for expenses or lost revenue attributable to an unrelated trade or business as defined in section 513. For more information, visit the Internal Revenue Services' website at https://www.irs.gov/newsroom/frequently-asked-questions-about-taxation-of-provider-relief-payments

Provider relief fund FAQs: https://www.hhs.gov/sites/default/files/provider-relief-fund-general-distribution-faqs.pdf

Please note: HHS continues to update the Provider Relief Fund FAQs. Please review them on a regular basis.

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July 14, 2020

APTA has provided broad guidance for members to consider when deciding whether or not to provide in-person/clinic-based care. http://www.apta.org/Coronavirus/Statement/.  APTA President Sharon Dunn also provided further clarification in a letter to members.  

Additional APTA resource:  Physical Therapist Management of Patients with Diagnosed or Suspected COVID-19

Workplace Toolkit provided by the Department of Licensing and Regulatory Affairs - excerpt below:

To further protect workers and the community, Gov. Gretchen Whitmer’s Executive Order 2020-147 reiterates that businesses who are open to the public must refuse entry and service to individuals who fail to comply with wearing a face covering. The Dept. of Labor and Economic Opportunity (LEO) stands at the ready to provide the tools necessary for businesses to protect their workers and remain safely open.

Under the governor’s order, businesses must post signs at all entrances instructing customers of their legal obligation to wear a face covering while inside – to assist employers with this requirement, a print-ready poster is available online. LEO and the Michigan Occupational Safety and Health Administration (MIOSHA) have a set of online resources at Michigan.gov/COVIDWorkplaceSafety that provides guidelines, posters for employees and customers, factsheets, educational videos and a reopening checklist to keep workplaces safe.

 

May 21 - Executive Order 2020-97 - Expanded Workplace standards to include provisions specific to outpatient health care facilities effective May 29.  Governor Whitmer issued Executive Order 2020-97, updating a prior rule on workplace safety. Per the amended order, outpatient health care facilities, including clinics, primary care physician offices, and dental offices, will have to adopt strict protocols to prevent infection. The Executive Order contains a number of requirements for all employers, as well additional requirements for health care operations. Be sure to carefully read Executive Order 2020-97 and implement these requirements in your practice, in addition to other regulatory guidance that remains in effect. Current guiding documents include:

LARA Frequently Asked Questions for Outpatient Facilities

Business Operations and Specific Guidance for Outpatient Health Care Facilities (Executive Order 2020-97)

Encouragement to use telehealth when available and appropriate (Executive Order 2020-86)

Protections against employer retaliations for workers who stay home (Executive Order 2020-36)

Best practices for screening procedures which are the foundation of all in-person clinic operations for patients and employees can be found in the CDC guidelines for Risk Assessment

Regulations regarding the re-opening of economy are changing rapidly. On Friday June 5, Executive Order (EO) 2020-114 was issued. EO 2020-114 replaces the recently issued EO2020-97 which applied to all businesses, and contained specific guidance for health care operations. EO 2020-114 has several important changes additions, and you should review this EO carefully to ensure you are in compliance. Several changes in EO 2020-114 compared to EO 2020-97 include:

 

1.k. When an employee is identified with a confirmed case of COVID-19: (1) Immediately notify the local public health department, and (2) Within 24 hours, notify any co-workers, contractors, or suppliers who may have come into contact with the person with a confirmed case of COVID-19. (l) An employer will allow employees with a confirmed or suspected case of COVID19 to return to the workplace only after they are no longer infectious according to the latest guidelines from the Centers for Disease Control and Prevention (“CDC”) and they are released from any quarantine or isolation by the local public health department

1.l. An employer will allow employees with a confirmed or suspected case of COVID-19 to return to the workplace only after they are no longer infectious according to the latest guidelines from the Centers for Disease Control and Prevention (“CDC”) and they are released from any quarantine or isolation by the local public health department.

10. All businesses or operations that provide in-home services, including cleaners, repair persons, painters, and the like, must:

a. Require their employees (or, if a sole-owned business, the business owner) to perform a daily health screening prior to going to the job site.

b. Maintain accurate appointment record, including date and time of service, name of client, and contact information, to aid with contact tracing.

c. Limit direct interaction with customers by using electronic means of communication whenever possible.

d. Prior to entering the home, inquire with the customer whether anyone in the household has been diagnosed with COVID-19, is experiencing symptoms of COVID-19, or has had close contact with someone who has been diagnosed with COVID-19. If so, the business or operation must reschedule for a different time.

e. Limit the number of employees inside a home to the minimum number necessary to perform the work in a timely fashion.

f. Gloves should be worn when practical and disposed of in accordance with guidance from the CDC.

 

13. Gymnasiums, fitness centers, recreation centers, sports facilities, exercise facilities, exercise studios, and like facilities must:

a. Post sign(s) outside of entrance(s) informing individuals not to enter if they are or have recently been sick.

b. Maintain accurate records, including date and time of event, name of attendee(s), and contact information, to aid with contact tracing.

c. To the extent feasible, configure workout stations or implement protocols to enable ten feet of distance between individuals during exercise sessions (or six feet of distance with barriers).

d. Reduce class sizes, as necessary, to enable at least six feet of separation between individuals.

e. Provide equipment cleaning products throughout the gym or exercise facility for use on equipment.

f. Make hand sanitizer, disinfecting wipes, soap and water, or similar disinfectant readily available.

g. Regularly disinfect exercise equipment, including immediately after use. If patrons are expected to disinfect, post signs encouraging patrons to disinfect equipment.

h. Ensure that ventilation systems operate properly.

i. Increase introduction and circulation of outdoor air as much as possible by opening windows and doors, using fans, or other methods.

j. Regularly clean and disinfect public areas, locker rooms, and restrooms.

k. Close steam rooms and saunas.

 

Regarding item 9.o., guidance for facility cleaning can be found on the CDC website https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

 

Regarding item 9.f, minimum items to be contained in screening procedures are outlined in Executive Order 2020-60 https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-527059--,00.html:

The screening procedures must include the following questions:

A. Do you have any of the following symptoms?

i. Fever of 100.4 degrees or higher (as measured by a touchless thermometer if available, but a verbal confirmation of lack of fever is sufficient if a touchless thermometer is not available);

ii. Cough (excluding chronic cough due to a known medical reason other than COVID-19);

iii. Shortness of breath;

iv. Sore throat; or

v. Diarrhea (excluding diarrhea due to a known medical reason other than COVID-19).

 

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July 01, 2020

The Chart found HERE is a complete, up to date listing of payer policies.

April 30 Update  - Telehealth Services now covered for Medicare Beneficiaries - see additional information in the Chart. https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

Additional BCBSM Resources:

Legislative Action:

Senate Bill 898 to amend the insurance code (1956 PA 218) requiring that a service provided through telemedicine will provide the same coverage and reimbursement as if the service involved face-to-face contact was introduced by Senator Adam Hollier on April 29, 2020 and was referred to the Health Policy Committee. This bill would also require insurers to continue to provide the same reimbursement for physical therapy provided via telehealth beyond the COVID-19 pandemic.

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December 30, 2019

The Physical Therapy Administrative Rules, which have the weight of law, have been revised and were officially adopted late December 2019. Click here for the new Rules.  Administrative rules are an interpretation and implementation of statute, and are periodically reviewed and revised, even when there has not been a change in statute.

This most recent revision included a variety of clarifications .  Click here for the summary provided by LARA.   One clarification has important implications for supervision of and delegation to an athletic trainer by a physical therapist in a physical therapist practice. The MPTA and the Michigan Athletic Trainers’ Society (MATS) have jointly written an informational memorandum to inform our respective members about this important clarification.

 

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April 24, 2017

The Physical Therapy Section of the Public Health Code has been amended to allow Advanced Practice Registered Nurses to prescribe physical therapy:

 

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****



333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

 

 

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

Section 17201:

Sec. 17201. (1) As used in this part:

(a) “Advanced practice registered nurse” or “a.p.r.n.” means a registered professional nurse who has been granted

a specialty certification under section 17210 in 1 of the following health profession specialty fields:

(i) Nurse midwifery.

(ii) Nurse practitioner.

(iii) Clinical nurse specialist.

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****

 


333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

 

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

 

 

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