View the OHSA requirements here: https://www.osha.gov/coronavirus/ets
New guidance effective June 1: https://www.michigan.gov/leo/0,5863,7-336-100207---,00.html
May 15 Gatherings and Face Mask Order: https://www.michigan.gov/documents/coronavirus/FINAL__-_Masks_and_Gatherings_order_-_5-14-21_signed_725417_7.pdf
This order remains in effect until June 1
Provisions that apply to outpatient settings:
- Gathering restrictions for other facilities.
- Gatherings in waiting rooms at outpatient health care facilities, veterinary clinics, and other businesses are prohibited unless the facility implements a system to ensure that persons not of the same group maintain 6 feet of distance. To the extent possible, this system must include a policy that patients wait in their cars for their appointments to be called.
- Indoor face mask requirement.
- Except as specified in section 7, all persons participating in indoor gatherings are required to wear a face mask.
- A person responsible for an establishment, or an agent of such person, must prohibit gatherings of any kind at their establishment unless the person makes a good faith effort to ensure that all persons at their establishment (including employees) comply with section 6(a). For purposes of this section, a "good faith effort" may include any of the following: posting a sign notifying people that wearing a mask is required unless a person falls into a specified exception; asking patrons not wearing masks whether they fall into a specified exception; requiring face masks of all patrons and employees; or any other policy designed to ensure compliance with section 6(a).
- Exceptions to face mask requirement. The requirement to wear a face mask at indoor gatherings does not apply to individuals who:
- Are fully vaccinated persons;
- Are younger than 2 years old;
- Cannot medically tolerate a face mask;
- Are eating or drinking while seated in a designated area or at a private residence;
- Are swimming;
- Are receiving a medical or personal care service for which removal of the face mask is necessary;
- Are asked to temporarily remove a face mask for identification purposes;
- Are communicating with someone who is deaf, deafblind, or hard of hearing and whose ability to see the mouth is essential to communication;
- Are actively engaged in a public safety role, including but not limited to law enforcement, firefighters, or emergency medical personnel, and where wearing a face mask would seriously interfere in the performance of their public safety responsibilities;
- Are engaging in a religious service;
- Are giving a speech for broadcast or to an audience, provided that the audience is at least 12 feet away from the speaker; or
- Are engaging in an activity that requires removal of a mask not listed in another part of this section, and are in a facility that provides ventilation that meets or exceeds 60 ft3/min of outdoor airflow per person.
Continuing Education Requirements - Waiver is no longer in effect
Under Executive Order 2020-61 (rescinded and replaced by Executive Order 2020-150 the continuing education requirements for renewing the license were waived at the time of renewal, if the renewal was completed while the state of emergency declaration is in effect. Governor Whitmer issued executive orders declaring a state of emergency - the most recent being Executive Order-186 which extended the state of emergency until October 27. As the EO is no longer valid, licensees renewing in 2021 are required to earn the full 24 PDR credits.
PDR Credits: Executive Order 2020-13, issued March 17, included the following:
- Effective immediately and continuing through April 14, 2020 at 11:59 pm, LARA may recognize hours worked responding to the COVID-19 emergency as hours toward continuing education courses or programs required for licensure.
Subsequent Executive Orders extended the provision. LARA posted an update for licensees that clarifies licensing issues, including PDR credits for hours worked in response to the COVID emergency. Hours worked March 17 - June 9, 2020, can be counted as PDR credits for those renewing in 2021. Unfortunately, LARA has not provided any further clarification as to what specific activities can be counted or how many hours can be counted. If COVID hours are used for PDR credits, licensees must be able to provide supporting documentation. The document below provides more detail and outlines what will suffice for documentation.
BPL Clarification for Licensees 
Download file
The Chart found HERE is a complete, up to date listing of payer policies. Last update: 1/11/21
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:
- BCBSM Telemedicine Services - note that this policy went into effect before May 1 due to COVID-19
- Telehealth services covered at no cost to the beneficiary
- PTOT benefit extension
- Covid-19:Determining members telehealth benefits
- Telehealth Procedure Codes for services provided at no cost for patients
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.
Information from APTA~
CMS Won't Pay Out on New Code for Additional Pandemic Costs
A code aimed at extra provider costs related to stopping the spread of the coronavirus won't result in more money.
You can lead Medicare to a code, but you can't make it pay.
Back in September, providers were encouraged when the American Medical Association announced it had updated its current procedural terminology code set to include a code for reporting expenses incurred as a result of the necessary public health response to the COVID-19 pandemic. The code — 99072 — was a new practice expense code that describes the additional supplies and clinical staff time required to provide safety measures during a public health emergency. In the current environment, it could be used to denote expenses related to stopping the spread of the coronavirus while still providing safe in-person visits.
Cut to Oct. 27, when the U.S. Centers for Medicare & Medicaid Services put the brakes on any additional payment directly related to the new code under Medicare.
In an MLN Matters update, the agency included 99072 among several codes that were being added to the 2020 Medicare Physician Fee Schedule, but with one important caveat: The code was assigned a "B" procedure status, meaning it is a bundled code and won't be associated with any relative value units and payment policy indicators won't apply.
"Basically, what CMS is saying is that this code doesn't warrant an additional payment on top of what providers are getting paid for the services rendered during that visit, " said Kara Gainer, APTA director of regulatory affairs. "Providers can still include it on the claim, but payment will be considered 'incident to' the treatment being provided that day, meaning that separate payment won't be provided."
According to Gainer, the commercial payment landscape is varied: some payers had already adopted this approach, others were waiting to see where Medicare landed, while still others are in fact paying on the code.
Our advice: Check with your state Medicaid programs and commercial insurers regarding eligibility for payment and coverage of the code.
Another important tip: Should a payer not adopt coverage for 99072, don't bill the cost associated with this code to the patient. And remember that providers must comply with state law, which could restrict the application of surcharges for additional supply expenses associated with the public health emergency.
https://www.apta.org/news/2020/11/04/cms-coding-decision-99072
FAQs
APTA Policy is clear that telehealth can be an appropriate model of care delivery of physical therapy services. http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/TelehealthHODPolicy.pdf#search=%22telehealth%22
Further, the FSBPT has a resource paper on important considerations for physical therapists utilizing telehealth https://www.fsbpt.org/Portals/0/documents/free-resources/TelehealthInPhysicalTherapy2015.pdf
Regulatory scope of practice is almost always more limiting than professional scope of practice, but there are also many instances of the Physical Therapy Section of the Public Health Code being silent on specific issues. When you look at the Public Health Code, there is nothing in the Physical Therapy section that specifically permits or prohibits telehealth. However, a quick search of the General Provisions, which apply to all licensed health professionals, reveals that telehealth is permitted to be provided by licensed health professionals in Michigan: http://www.legislature.mi.gov/(S(0dsbzvzpxu4lawibsw5ym4q2))/mileg.aspx?page=GetMclDocument&objectname=mcl-368-1978-15-161
From a state regulatory scope of practice perspective, telehealth is permitted by physical therapists:
333.16283 Definitions.
Sec. 16283.
As used in this section and sections 16284 to 16288:
(a) "Health professional" means an individual who is engaging in the practice of a health profession.
(b) "Prescriber" means that term as defined in section 17708.
(c) "Telehealth" means the use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine. As used in this subdivision, "telemedicine" means that term as defined in section 3476 of the insurance code of 1956, 1956 PA 218, MCL 500.3476.
(d) "Telehealth service" means a health care service that is provided through telehealth.
Further, the Insurance Code (MCL 500.3476) offers additional guidance:
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer. Telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the health insurance policy agreed upon between the policy holder and the insurer, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.
(2) As used in this section:
(a) After December 31, 2017, "insurer" includes a nonprofit dental care corporation operating under 1963 PA 125, MCL 550.351 to 550.373.
(b) "Telemedicine" means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the patient must be able to interact with the off-site health care professional at the time the services are provided.
Further information regarding "scope of practice."
Expanding your professional boundaries is the epitome of professional practice because a good clinician is always learning. As you consider the directions in which you would like to grow, you also need to understand the legal/regulatory constraints that may impact your decision.
"Scope of Practice" is a broad term that includes: 1) professional scope of practice as defined by CAPTE entry-level education standards, APTA positions and policies, and FSBPT resource papers, 2) regulatory scope of practice as defined by state law, and 3) personal scope of practice as defined by your individual experiences and professional development. Other factors that affect your practice include third party payer regulations and facility policies.
All of the resources for determining professional scope of practice can be found at: http://www.apta.org/ScopeOfPractice/. Among the numerous links available is the link to the APTA Policies related to practice http://www.apta.org/Policies/Practice/
Resources related to regulatory scope of practice in MI can be found at: https://www.michigan.gov/lara/0,4601,7-154-72600_72603_27529_27549---,00.html
Especially important are the links to the Physical Therapy section of the Public Health Code, the General Provisions of the Public Health Code, the Administrative Rules, and the FAQs. Licensing and Regulatory Affairs (LARA), in consultation with the MI Board of Physical Therapy (aka the PT Licensure Board), promulgate the administrative rules and the FAQs which are an interpretation/application/operationalization of the Public Health Code, and have the force of law. Navigating the legalese of regulatory scope of practice can be challenging, but APTA Michigan is here to help. One of the many member benefits is the ability to ask APTA Michigan leaders questions about practice. Although the APTA Michigan cannot offer legal advice, it can provide highly informed guidance.
Even during a pandemic, you must follow all applicable laws and regulations for practice as a physical therapist/physical therapist assistant, including meeting all applicable professional practice standards for patient management and documentation, as well applicable laws regarding scope of practice, direct access (e.g. the 10 visit/21 day limit), PTA supervision/delegation, etc. The only direct/explicit regulatory/scope of practice change was Executive Order 2020-30 allowing physical therapists to work as respiratory therapist extenders. If you are redeployed in another role (working as a nursing tech, helping in a triage tent, working on a mobility team, etc) it is important to recognize that you might not practicing as a physical therapist/physical therapist assistant in that capacity. Rather, you might be functioning as an unlicensed individual under another provider's license (e.g. physician etc) who is delegating acts, tasks, and functions to you. In these instances, you should not represent yourself or your services as a physical therapist/physical therapist assistant/physical therapy, and you should be sure that roles and responsibilities as clearly outlined. The breadth and depth of the knowledge and skills possessed by a PT/PTA are what make PTs/PTAs so versatile during crises such as the present COVID-19 crisis which allow us to be redeployed in creative and useful ways and allow PTs/PTAs to provide an wide array of acts, tasks, and functions delegated by other health care providers. You just want to be clear on when you are truly providing physical therapy as a physical therapist/physical therapist assistant and follow all laws and regulations.
There are no regulatory restrictions on delegation of services provided via telehealth, and the requirement for general supervision of the PTA (i.e. available via telecommunications) still applies. However, all of the other requirements for delegation to and supervision of a PTA also still apply. Therefore, the PT should only delegate provision of telehealth to a PTA when it is appropriate to do so based on the individual patient and the PTA to whom services are being delegated. The Administrative Rules regarding PTA supervision and delegation are detailed in R 338.7138 and can be found in the Board of Physical Therapy General Rules found here: https://aptami.org/practice/. The APTA Michigan is not aware of any payer-specific prohibitions on delegation of telehealth services to PTAs.
Statute and the PT rules do not provide any details regarding application of the direct access provisions in this circumstance. The APTA Michigan believes that the statutory intent of direct access was for an initial encounter/start of a new plan of care for a new problem or for a recurring problem that was previously resolved/adequately treated. Therefore, as your clinic resumes operations and if you are resuming a plan of care established before the COVID-19 crisis, the APTA Michigan believes that it would be inappropriate to do so under the direct access provisions and that you would need to update/revise the initial prescription. However, please know that APTA Michigan is exploring temporary remedies and options to help eliminate this issue as clinics restart operations.
Additional Resources
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APTA Information
- Physical Therapist Management of Patients With Diagnosed or Suspected COVID-19 - Includes information for outpatient facilities, inpatient facilities, and home health.
- Telehealth and E-visits - APTA guidance for providing telehealth services and e-visits amid COVID-19.
- APTA Coronavirus (COVID-19) Updates - APTA has provided multiple updates chronicling the rapid evolution of COVID-19 guidance and related regulations. (April 14, 2020)
