APTA Michigan News

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.

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.

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.

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.