In The News

APTA-Endorsed Bill Would Make Telehealth for PTs, PTAs Permanent Under Medicare

APTA

In light of telehealth’s effectiveness during the PHE, this longtime APTA advocacy goal could be within reach.

The possibility that Medicare payment for telehealth services delivered by PTs and PTAs could be made permanent is back on the table, courtesy of an APTA-endorsed bipartisan bill that has been introduced in the U.S. House of Representatives. If passed into law, the change would represent a milestone achievement for APTA, whose advocacy for PTs and PTAs to be included in telehealth allowances predates the COVID-19 pandemic, when temporary waivers were introduced.

Known as the Expanded Telehealth Access Act (H.R. 3875), the bill is sponsored by Reps. Diana Harshbarger, R-Tenn., and Mikie Sherrill, D-N.J. The legislation mirrors the language of a bill introduced in the last session of Congress, which was not taken up in time before their adjournment in December. Instead, Congress extended the current temporary ability of therapists to use telehealth under Medicare until Dec. 31, 2024, to provide more time to formulate a permanent telehealth policy.

Once again, APTA is urging all PTs, PTAs, students, patients, and other supporters to contact members of Congress by way of the APTA Patient Action Center to voice their support for the new bill.

As in its previous incarnation, the bill would instruct the U.S Centers for Medicare & Medicaid Services to permanently adopt the temporary waiver of restrictions on payment for telehealth delivered by PTs and PTAs, occupational therapists, occupational therapy assistants, speech-language pathologists, and audiologists. The Secretary of Health and Human Services also would be allowed to further expand the list of authorized telehealth providers.

Harshbarger says there's no time to waste.

“It is critical that Congress acts to allow seniors to continue [telehealth] services permanently after special waivers expire in 2024," Harshbarger said in a statement. "This is especially important for people living in rural and underserved areas, where a trip to seek specific treatments may entail a long journey. This bill will enable seniors to continue receiving quality, accessible care, delivered in the most efficient way possible.” 

In a press release announcing the bill's introduction, Sherrill described the therapy provided through telehealth as a "lifeline," stating that "while the public health emergency is over, the need for telehealth services is not."

APTA President Roger Herr, PT, MPA, applauded the bill on behalf of the association. "The use of telehealth during the pandemic helped ensure patient access to physical therapist services and provided an option for therapy clinics and their patients," Herr said in an APTA news release. "It is critical that Congress make this option for therapy services permanent for Medicare patients."

If the success of telehealth provided by PTs and PTAs during the public health emergency helped build the momentum for a permanent fix, the U.S. Centers for Medicare & Medicaid Services' recent misinterpretation of the telehealth extension provided by Congress after the end of the PHE put even more wind in the sails, according to Steve Kline, APTA congressional affairs specialist.

"While APTA was pleased that CMS corrected their misinterpretation, it points to why we need a permanent telehealth policy under Medicare," Kline said. "We've always known PTs and PTAs could make significant contributions in the telehealth space, and the public health emergency proved that to be true. Now it's time for CMS to be granted the ability to embrace that reality." 

Get Involved
It's time to make telehealth a permanent option for PTs and PTAs. APTA makes it easy to add your voice to the effort: PTs, PTAs, students, patients, and others can send messages to lawmakers by way of the APTA Patient Action Center. Just follow the instructions for contacting members of Congress.
 

Third Try’s the Charm? National Labor Relations Board (Again) Narrows Definition of “Independent Contractor” Under the National Labor Relations Act

By Jim Paretti, Fred Miner, and David Ostern

On June 13, 2023, the National Labor Relations Board (“NLRB” or “the Board”) issued its long-awaited decision in The Atlanta Opera,1 in which it overturned prior law (SuperShuttle DFW, Inc.) and reinstated a narrower test for “independent contractor” (as opposed to “employee”) under the National Labor Relations Act (“NLRA” or “the Act”). As a practical matter, this means that more workers are likely to be classified as employees—who, unlike independent contractors, are permitted to form and join a union, and otherwise enjoy the workplace protections of the Act—than under prior law. The decision is not wholly surprising, insofar as NLRB General Counsel Jennifer Abruzzo announced early in her tenure that convincing the Board to overturn SuperShuttle was among her top priorities. The Atlanta Opera was approved three to one, with the Board’s single Republican member concurring in the result of the case but dissenting from the Board’s analysis and overruling of prior precedent.

In The Atlanta Opera, the Board reinstated the common-law agency test for determining worker status found in the Restatement (Second) of Agency §220.  Under that test, the Board looks at the following factors, assessing and weighing them, with no one factor being decisive:

  • The extent of control, which by agreement, the employer may exercise over the details of the work.
  • Whether or not the one employed is engaged in a distinct occupation or business.
  • The kind of occupation, with reference to whether, in the locality, the work is usually done under the direction of the employer or by a specialist without supervision.
  • The skill required in the particular occupation.
  • Whether the employer or the workman supplies the instrumentalities, tools and the place of work for the person doing the work.
  • The length of time for which the person is employed.
  • The method of payment, whether by the time or by the job.
  • Whether or not the work is part of the regular business of the employer.
  • Whether or not the parties believe they are creating the relation of master and servant.
  • Whether the principal is or is not in business.

Applying this test, the Board concluded that subject makeup artists and hairstylists working for the Atlanta Opera were employees, not independent contractors. The Atlanta Opera marks another chapter in a 16+ year saga concerning the definition of independent contractor under the Act, which has already twice gone to the U.S. Court of Appeals for the District of Columbia Circuit, and seems destined to make a third visit.

Read Full Article
 

Colorado Enacts Legislation Restricting Employers from Requesting Age-Related Information from Job Applicants

​Health Care Association of America (HCAOA)

On June 2, Colorado Gov. Jared Polis signed into law Senate Bill 23-058, the Job Application Fairness Act (JAFA), prohibiting employers from inquiring about a job applicant’s age during the hiring process. JAFA’s enactment adds to the requirements and proscriptions Colorado has implemented in the hiring process, including a “ban-the-box” restriction on inquiring about criminal histories and requiring the inclusion of salary and benefits information in job postings.

Click here to learn more from HCAOA partner Littler.
 

Many Older Adults with Dementia Experience Recurrent ED Visits, Study Finds

McKnight’s Home Care
 
A “significant portion” of community-dwelling older adults with dementia display a pattern of repeated emergency department (ED) visits, according to a study published Wednesday by the American Geriatrics Society (AGS).
 
The “population-based retrospective cohort study,” which analyzed ED visits among community-dwelling adults 66 years and older in Ontario, Canada, over a nearly 10-year period, also found that frequent users of anticonvulsants, antipsychotics and benzodiazepines had the highest risk of recurrent ED visits. 
 
Of the over 175,000 older adults studied, two groups — Group J (10,365 individuals) and Group L (7,353 individuals) — were deemed to be at a “higher-risk” of recurrent ED visits. Both groups included more individuals residing in rural and low-income areas and also having higher usage rates of anticonvulsants, antipsychotics, and benzodiazepines.
 
Dementia prevalence is expected to increase globally, from 57 million in 2020 to 153 million by 2050, but higher healthcare costs and barriers to diagnosis and care access are creating health disparities, the study said. 
 
The study also found that a history of an ED visit or visits during the prior year was the strongest predictor of recurrent visits and perhaps the most useful for identifying older adults in need of interventions.

Read Full Article
 

CMS Releases New Consumer-Friendly Resources for the No Surprises Act

[On June 14], the Centers for Medicare & Medicaid Services (CMS) made available new consumer-friendly web pages for people with easy-to-read information regarding the consumer protections in the No Surprises Act.

The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

Unexpected medical bills are a significant source of stress, frustration, and confusion for people in the United States. The No Surprises Act gives them new rights to prevent, navigate, and find resolutions to many of these “surprise” bills. 

To help consumers understand their rights, consumer-friendly web pages are now available for people with easy-to-read information and actionable guidance. The webpages’ design and content were informed by human-centered design research and user testing with patients, caregivers, patient advocates, and others.   

The webpage aims to be inclusive and accessible by: 

  • Meeting Web Content Accessibility Guidelines (WCAG 2.1 AA)
  • Providing all information in both English and Spanish
  • Using plain language and clean design
  • Centering the human experience with diverse and colorful illustrations
  • Building the site to be responsive to different devices, including mobile phones and tablets
  • Offering clear and multiple pathways for people to learn about their rights

When people visit the consumer website, they’ll be guided through: 

  • Understanding their rights under the No Surprises Act, including out-of-network billing protections and good faith estimates for future care
  • Identifying actions they can take to exercise their rights and find a resolution if they receive an unexpected medical bill, using a Q&A tool that asks about their situation
  • Submitting a complaint if they think their provider, facility, or insurance company didn’t follow the rules of the No Surprises Act through an optimized process and redesigned form
  • Disputing a bill if they are uninsured or didn’t use insurance and they were charged more than their good faith estimate
  • Finding guides that will help them navigate medical billing questions, as well as learning how to connect with the No Surprises Help Desk

Resources:
 
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