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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June 11, 2020

Message from the APTA Michigan President, Michael Shoemaker, on Social (In)Justice on Behalf of APTA MI and the Board of Directors

As we all continue to reflect on the tragic events in Minneapolis where George Floyd has become yet another example of racism and social injustice. We are reminded of other similar tragic losses: Ahmaud Arbery, Breonna Taylor, Michael Brown, and Freddie Gray. It is all too easy for some of us to feel hopeless, remain silent, and fall into complacency.

George Floyd’s tragic death is not just a law enforcement problem. It is a societal problem. APTA’s vision is to transform society. #BlackLivesMatter is a call to all of us to reflect inwardly and respond to our ethical obligation to fight racism.

If you have not yet done so, please read APTA President Sharon Dunn’s address to the House of Delegates (https://www.apta.org/PresidentLetter/2020/5/31/). She concludes that racism “…is a disease of the heart and mind that has infected not just people but customs, systems, and laws. There is no vaccine. We must be the cure.”

I urge you to accept her charge and find your own way to be a part of the cure. Compassion and caring is one of our professional core values. Listen, learn, and follow the lead of those with lived experience with racism. Address your own unconscious bias as you interact with others in your profession, your place of employment, and your community.

Last year, APTA MI commissioned a Diversity, Equity, and Inclusion Committee. Perhaps this is one way you might feel compelled to serve as this Committee develops a roadmap for promoting social justice for APTA MI. Or, perhaps you will seek additional education and training in social determinants of health and how to implement steps in your practice in order to do your part in addressing the ways in which racism and social injustice manifest in our healthcare system. https://learningcenter.apta.org//Student/Catalogue/BrowseCatalogue.aspx?query=social%20determinant The possibilities for you to make an individual difference every day and in every interaction are endless.

The APTA MI strategic plan includes promotion of diversity, equity, and inclusion within the chapter to mirror the communities we serve. The urgency of meeting this objective has never been more important. APTA MI stands with Black, Indigenous, and People of Color and the National Association of Black Physical Therapists and its components. We are a community that condemns racism, discrimination, and violence. We are committed to the pursuit of social justice within healthcare and beyond.

 

 

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May 19, 2020

On May 14, MPTA and 20 other health care associations sent a letter to Governor Whitmer asking that she rescind EO 2020-17 which mandates the postponement of non-essential health care procedures. The Governor was asked to issue a new Executive Order that would allow health care services to resume in accordance with identified safety protocols.

Click Here to download the letter

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April 24, 2020

http://www.apta.org/PTinMotion/News/2020/04/21/NCCIWin/

Life just got a little easier for PTs dealing with CMS National Correct Coding Initiative edits, known as NCCI edits, that prevented reimbursement for certain activity and evaluation codes when used on the same day unless a modifier was appended to the claim. In response to APTA's efforts to show how the coding changes were impacting care and complicating payment, CMS has backed off on many of the edits that were making reimbursement problematic, likely in large part due to the burden being imposed on providers by the COVID-19 public health emergency.

The Coding Changes
In private practice and institutional settings, PTs are now able to pair the following code combinations without the use of 59 or X modifiers:

97530 with 97116
97161 with 97140
97162 with 97140
97163 with 97140
99281-99285 with 97161-97168
97110 with 97164
97112 with 97164
97113 with 97164
97116 with 97164
97140 with 97164
97150 with 97110
97150 with 97112
97150 with 97116
97150 with 97164

There are additional edit changes as well, and APTA’s National Correct Coding Initiative webpage includes a table of the common edits that remain. Check back regularly as some of these edit changes may be temporary and could be reversed after the COVID-9 public health emergency ends.

Which Payers These NCCI Edit Changes Apply to
Medicare and Medicaid programs follow CMS’ NCCI procedure-to-procedure edits. Additionally, most insurers also follow the NCCI PTP edits. As such, APTA recognizes that providers may receive denials on the commercial side related to these edits if they fail to use the applicable 59 or X modifier. Commercial payers may not realize the files have been updated. APTA encourages providers to use the information in this article and found on the CMS PTP Coding Edits webpage to communicate with commercial payers regarding these edit changes.

 

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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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