APTA Michigan News

May 2022 – Michigan Moves Month

May 2, 2022

APTA Michigan is working with other health-related organizations to increase awareness about the benefits of physical activity during the month of May.

The Michigan Moves Month initiative was supported by the Governor in her April 29 Proclamation.

APTA Michigan will be sharing more information about this initiative throughout the month of May.

 

BCBSM Medicare Plus Blue Update – No Longer Need Prior Authorizations

April 25, 2022

BCBSM Update – April 2022

Outpatient PT, OT services no longer require prior authorization for Medicare Plus Blue members

 

For dates of service on or after April 1, 2022, Medicare Plus Blue℠ will no longer require prior authorization for outpatient physical and occupational therapy services. You can submit retroactive authorization requests to eviCore healthcare®** through July 29, 2022, for dates of service prior to April 1, 2022.

We’ll update the Medicare Plus Blue PPO Provider Manual and other documents to reflect this change.

These services will be managed by a network performance management company later this year. We’ll publish a provider alert and an article in a future issue of The Record with more details.

**eviCore healthcare is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services. For more information, go to our ereferrals.bcbsm.com website.

PTs and PTAs Now Mandatory Reporters of Child Abuse

April 8, 2022

PTs and PTAs are now mandatory reporters of child abuse and neglect as of March 25, 2022. This means that if you suspect child abuse or neglect you are now legally required to report it to authorities and are protected under the law when you act out of good faith.

If you suspect abuse or neglect, report it any time day or night online (https://newmibridges.michigan.gov/s/isd-landing-page?language=en_US) or by calling 855-444-3911.

Click HERE for Resources for Mandatory Reporters:  This website includes training, potential signs of abuse/neglect, and reporting links.

or look up “mandatory reporter” on michigan.gov

Guide to Mandatory Reporting

MDHHS Form a reporter will be asked fill out when calling in (must be done within 72 hours of calling in)

 

APTA Michigan supported legislation to enact this change as it provides additional protections for physical therapy professionals.

HB 4880

March 23, 2022

HB 4880 which adds PTs and PTAs to the list of health care professionals that are mandated to report child abuse passed the Senate today 38-0.  The bill will now go to the Governor for final approval.  APTA Michigan thanks Reps. Hauck and Yaroch for introducing the bill and supporting it throughout the process.

Physical therapy professionals will now have protection under the Michigan Child Protection Law which provides both civil and criminal immunity for reports made in good faith.

New Prior Authorization/Utilization Management Resource

March 11, 2022

APTA and the Private Practice Section have developed a new member benefit to ease administrative burden so physical therapists can spend more time caring for patients. The State Payer Advocacy Resource Center is aimed at addressing state-level administrative burden and utilization management issues with commercial payers, state Medicaid programs, and more. APTA and PPS collaborated on this suite of payment advocacy tools, hosted as a resource center on the PPS website and available free to all APTA members.

HB 4880 Passed by the Senate Committee on Health Policy and Human Service

March 10, 2022

HB 4880 was just passed out of committee unanimously.  This bill was voted on and passed in the House in November 2021.  The next step is a full Senate vote which may happen this month.

From Gongwer News Service Inc. after APTA Michigan testimony last week:

Mandatory reporting requirements could be expanded to include physical therapists and physical therapist assistants under legislation, supporters of which say it could provide them protections when reporting child abuse and neglect.

HB 4880 Track , sponsored by Rep. Roger Hauck (R-Mount Pleasant), was up for testimony only when it came before the Senate Health Policy and Human Services Committee Track on Thursday.

Mr. Hauck’s legislative director, Alex Porrett, told the panel that new additions within the bill are in fields like other mandatory reporters, such as medical professionals and licensed counselors. This is because of their relationship with patients and the training many of them receive to identify signs of abuse.

Occupational therapists and athletic trainers would also be included as mandatory reporters under the bill.

Dr. Abigail Skallerud, director of legislative affairs for the American Physical Therapy Association – Michigan Chapter, said her organization has been championing for this initiative for years. She echoed Mr. Porrett’s statement by that physical therapists and physical therapist assistants have been trained to recognize child abuse.

“For years, PTs and PTAs have been reporting cases of suspected child abuse and neglect over the years as we have been permitted under the Child Protection Law, even though we’re not required to dos so,” Ms. Skallerud said. “This bill remedies that loophole and increases the accountability of a physical therapist and the physical therapist assistant on behalf of children in our state. And it also adds added legal protections for us as PTs and PTAs if we do suspect the child abuse and neglect occurring.”

She also said the Child Protection Law provides civil and criminal immunity for those who make a report in good faith.

Committee Chair Sen. Curt VanderWall (R-Ludington) asked if someone does come into the office showings signs of abuse, how do physical therapists and physical therapist assistants handle the situation. Ms. Skallerud said depending on the workplace, they will either report to law enforcement or to social workers the suspected abuse and follow whatever guidance they are given from that point on.

He then questioned if that takes responsibility off physical therapists and their assistance, asking Ms. Skallerud why she saw “the benefit of being able to work” under the bill.

“If we do (report) right now, we’re protected under the Good Samaritan laws, but we are not protected underneath the actual mandatory reporting laws,” she said. “So for us if we are wrong, we don’t get the same protection as other health care professionals currently.”

Vaccine Mandate for Healthcare Providers

January 27, 2022

The information below was updated by APTA on January 20. Visit the APTA website to download  this document:  APTA Practice Advisory: CMS COVID-19 Health Care Staff Vaccination Rule

 

APTA issued this guidance on November 5:

The U.S. Centers for Medicare & Medicaid Services and the Occupational Safety and Health Administration have released their expansive new rules on coronavirus vaccines. The CMS rule, which essentially mandates vaccination with limited exceptions, applies to an estimated 76,000 health care facilities and 17 million workers, while OSHA’s rule requiring vaccination or weekly testing is focused on all entities with 100 or more employees. Both rules officially went into effect on Nov. 5, with full compliance expected by Jan. 4, 2022.

What does it all mean for PTs and PTAs? Our latest APTA Practice Advisory provides an in-depth look at the CMS rule to help members navigate the requirements. It’s highly recommended reading, but for a quick overview, here are six things you should know about the new rules right now.

1. If you work for just about any health care facility, the CMS rule probably applies to you.
The CMS rule requires vaccination for staff associated with any facility regulated by Medicare conditions of participation or conditions for coverage. That’s a large swath that includes everything from nursing homes to ambulatory surgical centers to clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services (see the APTA Practice Advisory for a detailed list). And it applies to not just health care providers, but to all current and future staff including students, trainees, and volunteers, as well as anyone who provides services under contracts or other arrangements with the facility.

2. The CMS rule doesn’t apply to private physical therapy practices.
The line between who does and doesn’t have to follow the new rule is drawn around the Medicare Conditions of Participation. Since private practices aren’t subject to those conditions, they are not addressed in the new rule.

3. First shots need to be received by Dec. 5, and the second before Jan. 4.
The CMS rule now in place has two compliance phases. At phase one, effective Dec. 5, all employees must have received their first vaccine dose or been granted a formal exemption (more on that below), and facilities must have policies and procedures in place for tracking compliance. Phase two begins on Jan. 4 — that’s the deadline for all employees to be fully vaccinated. Employees who are fewer than 14 days from their second shot by then will need to take additional safety precautions until those days are up.

4. There are (limited) exemptions.
If you work 100% remotely, you aren’t subject to the CMS requirements. The rule also carves out the potential for exceptions based on medical conditions and religious beliefs. Facilities are permitted to develop their own policies and procedures for making exception determinations, but they must follow applicable federal law, and in the case of medical exemptions they must document the specific contraindications and include a statement from a health care practitioner affirming the need for an exemption. The exempted employees must in turn receive accommodations in line with Equal Employment Opportunity Commission guidelines.

5. The rule has teeth.
Facilities need to take the new rule seriously. For nursing homes, home health agencies, and hospice the ramifications of noncompliance include monetary penalties, denial of payment, and even termination from the Medicare and Medicaid program as a final measure. The remedy for noncompliance among hospitals and certain other acute and continuing care providers is termination. At the same time, CMS says its goal is to bring health care facilities into compliance, and that termination would be a last resort. For more detail, check out the APTA Practice Advisory.

6. If the CMS rule doesn’t apply to you, the OSHA rule might.
Although the vast majority of PTs and PTAs affected by the new rules are subject to the CMS version, it’s also possible that some may be required to follow the new OSHA requirements. That rule, which applies to employers with 100 or more employees, takes a bit less stringent approach than CMS does, requiring either a full course of vaccine or weekly COVID-19 testing. The vaccine will be supplied to employees free of charge, but employers aren’t required to pay for either testing or masks, and could pass along these costs to their nonvaccinated employees. Check out the entire OSHA rule.

Coding Edits Changed to allow Manual Therapy and Multi-Layer Compression in Same Visit

January 12, 2022

Update to the previous post:

APTA is seeking clarification from CMS. We have updated our news story to indicate that this discrepancy remains and we will provide an additional update as soon as we hear from CMS. Right now, the ability to bill for multilayer compression with manual therapy is limited to non-lymphedema conditions.

Previous Post:

Due to advocacy efforts by APTA, according to the most recent National Correct Coding Initiative edits, providers can now use CPT codes 29581-29584 (multi-layer compression systems) during the same episode as code 97140 (manual therapy) — a combination that often makes clinical sense, but wasn’t always permitted.

In terms of exactly how the codes should be reported, CMS advises that it may be necessary to use the 59 or X modifier to indicate that the two activities are distinct from each other. APTA provides guidance on the use of the X and 59 modifiers in this easy-to-use decision tree.

Mandatory Reporting Legislative Update

January 7, 2022

HB 4880 PTs and PTAs as Mandatory Reporters of Child
Abuse and Neglect

Our Legislative Director, Jena Colon, testified on 10/26/2021, and the bill successfully passed out of committee 12-0-1 vote on the same day. On 11/9/2021, this bill passed out of the House successfully, with a vote of 101 – 3!!

On 11/10/2021, this bill was referred to the Senate Health Policy Committee.  We hope to move this out of committee and to the full Senate for a vote in the near future.

Implicit Bias Training – Requirements for License Renewal

June 9, 2021

On June 1, the Department of Licensing and Regulatory Affairs (LARA) announced new requirements for over 400,000 health care professionals licensed in Michigan.  Licensees who have email addresses listed with the Bureau of Health Professions/LARA should have received an email outlining the new requirement.  That message is copied below.  Licensees renewing in 2021 will not be impacted.  Those renewing in 2022 will need 2 hours of implicit bias training.  APTA Michigan is developing course content to meet this new requirement and we hope to offer both sessions at our conferences along with live webinars.

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Dear Licensee –

The Bureau of Professional Licensing (BPL) within the Department of Licensing and Regulatory Affairs (LARA) would like to inform you that the Public Health Code – General Rules have been revised which will require implicit bias training for your profession, effective June 1, 2022.

The new training requirements are the product of numerous workgroup meetings over the past year and represent feedback from 86 organizations including our health professional boards, insurance providers, health systems, health care associations, legislators, state agencies, higher education, and community and advocacy groups. The requirements apply to both new applicants as well as those renewing their existing licenses or registrations.

Below are the changes in the rules that pertain to the new training requirements:

  • The term “implicit bias” is defined as:

(A)n attitude or internalized stereotype that affects an individual’s perception, action, or decision making in an unconscious manner and often contributes to unequal treatment of people based on race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, socioeconomic status, age, disability, or other characteristic. (R 338.7001 (c) )

  • Specifically, the new rule (R 338.7004) requires the following:

Rule 4. (1) Beginning 1 year after promulgation of this rule, an applicant for licensure or registration under article 15 of the code, MCL 333.16101 to 333.18838, except those seeking to be licensed under part 188 of the code, MCL 333.18801 to 333.18838, shall have completed a minimum of 2 hours of implicit bias training within the 5 years immediately preceding issuance of the license or registration.

(2) Beginning 1 year after promulgation of this rule and for every renewal cycle thereafter, in addition to completing any continuing education required for renewal, an applicant for license or registration renewal under article 15 of the code, MCL 333.16101 to 333.18838, except those licensed under part 188 of the code, MCL 333.18801 to 333.18838, shall have completed a minimum of 1 hour of implicit bias training for each year of the applicant’s license or registration cycle.

(3) The implicit bias training must be related to reducing barriers and disparities in access to and delivery of health care services and meet all of the following requirements:

(a) Training content must include, but is not limited to, 1 or more of the following topics:

(i) Information on implicit bias, equitable access to health care, serving a diverse population, diversity and inclusion initiatives, and cultural sensitivity.
(ii) Strategies to remedy the negative impact of implicit bias by recognizing and understanding how it impacts perception, judgment, and actions that may result in inequitable decision making, failure to effectively communicate, and result in barriers and disparities in the access to and delivery of health care services.
(iii) The historical basis and present consequences of implicit biases based on an individual’s characteristics.
(iv) Discussion of current research on implicit bias in the access to and delivery of health care services.

(b) Training must include strategies to reduce disparities in access to and delivery of health care services and the administration of pre- and post-test implicit bias assessments.

(c) Acceptable sponsors of this training include any of the following:

(i) Training offered by a nationally-recognized or state-recognized health-related organization.
(ii) Training offered by, or in conjunction with, a state or federal agency.
(iii) Training obtained in an educational program that has been approved by any board created under article 15 of the code, MCL 333.16101 to 333.18838, except under part 188 of the code, MCL 333.18801 to 333.18838, for initial licensure or registration or for the accumulation of continuing education credits.
(iv) Training offered by an accredited college or university.
(v) An organization specializing in diversity, equity, and inclusion issues.

(d) Acceptable modalities of training include any of the following:

(i) A teleconference or webinar that permits live synchronous interaction.
(ii) A live presentation.
(iii) Interactive online instruction.

(4) Submission of an application for licensure, registration, or renewal constitutes an applicant’s certificate of compliance with the requirements of this rule. A licensee or registrant shall retain documentation of meeting the requirements of this rule for a period of 6 years from the date of applying for licensure, registration, or renewal. The department may select and audit a sample of a licensees or registrants and request documentation of proof of compliance with this rule. If audited by the department, a licensee or registrant shall provide the proof of completion of training, including either of the following:

(a) A completion certificate issued by the training program that includes the date of the training, the program sponsor’s name, the title of the program, and licensee’s or registrant’s name.

(b) A self-attestation by the licensee or registrant that includes the date of the training, the program sponsor’s name, the title of the program, and licensee’s or registrant’s name.

Please send any questions you may have about these revised rules to BPLHelp@michigan.gov .

Thank you,

Debra Gagliardi, Director
Bureau of Professional Licensing
Department of Licensing and Regulatory Affairs


LARA is an equal opportunity employer/program.

Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

BUREAU OF PROFESSIONAL LICENSING
P.O. BOX 30670· LANSING, MICHIGAN 48909
www.michigan.gov/bpl

For more information about LARA, please visit www.michigan.gov/lara

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