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CMS Opens Medicare Telehealth Waivers to Include Physical, Occupational, Speech Therapists

Published Thursday, April 30, 2020
by Alex Spanko

More than a month after the federal government issued widespread waivers to expand telehealth coverage amid the COVID-19 pandemic, therapists will finally be able to provide remote interventions under Medicare.

The Centers for Medicare & Medicaid Services (CMS) on Thursday announced that it will allow physical, occupational, and speech therapy practitioners to provide Medicare-covered telehealth services as long as a federal coronavirus emergency declaration remains in effect.

“For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services,” CMS said in an announcement. “Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.”

The lack of PT, OT, and SLP coverage was a major sore spot for therapists and their advocates, who were forced to navigate a world in which their services were still required — but in which nursing homes’ doors were largely shut to non-essential personnel due to coronavirus concerns.

Therapy professionals were able to provide some types of remote services, including e-visits and video conferences conducted between different rooms within the same facility.

Thursday’s announcement brings PTs, OTs, and SLPs on par with the other providers that have embraced the government’s telehealth flexibilities to potentially treat residents in place at skilled nursing facilities and other institutional care sites — a key weapon in the fight to maintain acute-care capacity and prevent the spread of COVID-19 in nursing facilities.

Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care (NASL), praised the news in an e-mail to SNN, but emphasized that more detail from CMS will be required to fully grasp the scope of the expansion.

“The therapy sector has pressed CMS to add rehab therapists to the list of eligible practitioners, and CMS looks to have answered that today, using their new waiver authority under the CARES Act to add therapists to the list,” Morton told SNN. “This is great news, but we are cautiously optimistic that this new authority extends to all settings. We are asking CMS for clarification.”

In particular, Morton wanted clarification that the flexibility explicitly applies to nursing facilities, which often count as “home” for other Medicare Part B-covered services.

“We are optimistic that the setting that we feel needs this authority in order to help prevent spread of COVID-19 — patients in nursing facilities — will get to use this technology to deliver services that are really needed,” Morton said. “We have patients isolated in rooms and they need therapy interventions to help keep them on the course to better health.”

In outpatient settings, physical and occupational therapists can delegate “maintenance therapy services” to PT and OT assistants.

“This frees up physical and occupational therapists to perform other important services and improve beneficiary access,” CMS noted.

CMS’s telehealth updates also included a boost in the rates for telephone consultations for doctors and other clinicians, raising them from a range of $14 to $41 to $46 to $110, as well as an temporary suspension of formal rulemaking around telehealth.

“CMS is changing its process during the emergency, and will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible,” CMS announced. “This will speed up the process of adding services.”

Speaking at a White House press conference, President Trump on Thursday said that the number of Medicare beneficiaries using telehealth has jumped from 11,000 to more than 650,000 per week in the wake of CMS’s waivers.

The president predicted that the telehealth expansion could become permanent even after the COVID-19 crisis passes.

“They get used to it, and a lot of that’s going to be staying with us long after this horrible scourge is gone,” Trump said.

The therapy news came amid a raft of new flexibilities from CMS, including an expansion of COVID-19 testing coverage, a relaxation of rules governing admissions to inpatient rehabilitation facilities (IRFs), and the suspension of some requirements for accountable care organizations (ACOs).

“I’m very encouraged that the sacrifices of the American people during the pandemic are working. The war is far from over, but in various areas of the country the tide is turning in our favor,” CMS administrator Seema Verma said in a statement. “Building on what was already extraordinary, unprecedented relief for the American healthcare system, CMS is seeking to capitalize on our gains by helping to safely reopen the American healthcare system in accord with President Trump’s guidelines.”

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