APTA Michigan News

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.


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.


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

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