PTA Updates

 2018 PTA Caucus Business Meeting – Summary
June 23 - 24, 2018 ∙ Orlando, FL  

Submitted by:
Lisa Stejskal, PTA, MAEd
NH APTA PTA Caucus Representative  

Forty-two PTA Caucus Representatives, 6 PTA Caucus Alternate Representatives, and 6 Delegates gathered in Orlando, FL, June 23 and 24 for the PTA Caucus Annual Meeting. Amy Smith, Chief Delegate presided over the meeting. The PTA Caucus Representatives from Arkansas, Hawaii, Iowa, Maine, Massachusetts, Rhode Island, and West Virginia were not in attendance. The District of Columbia does not have PTA Caucus Representative currently serving.

 

The PTA Caucus Nominating Committee conducted candidate interviews and elections. Those elected to serve are: David Harris (TN) as Chief Delegate, Drew Wilcox (UT) as Alternate Delegate, Rachel Winthrop (MN) to the Nominating Committee. Jimmy Pacini (CA) was elected in a Special Election to fulfill the 2-year term vacated by David Harris. Outgoing Alternate Delegate Jimmy Pacini (CA), outgoing Nominating Committee Member Christina Wilson (AL), and outgoing Chief Delegate, Amy Smith (AL) were recognized.  Appreciation and recognition was shown to Jodi Pfeiffer (AK) and Amy Smith (AL), the 2018 Outstanding Physical Therapist Assistant Award co-recipients. The PTA Caucus would also like to recognize and thank our many colleagues achieving advanced proficiency throughout the year. 

 

PTAC business included updates from APTA staff Sandra Wise, Justin Elliott, Justin Moore, and Derek Stepp. APTA President Sharon Dunn congratulated the Caucus on the strides made recently to better integrate PTAs into the APTA Community. PTAC Rep and Federal Affairs Liaison Rachel Winthrop (MN) provided an update, and PT-PAC trustee Eva Norman enthusiastically persuaded every Rep in room to donate to the PAC, achieving 100% participation from the PTA Caucus. A motion to send a recommendation to the APTA Board of Directors to create a Chief-Elect and Immediate-Past Chief position within the PTAC was unanimously approved. 

 

2018 House motions were discussed with specific attention paid to RCs 53, 54, and 55. A poll held during these discussions showed 59% of Reps directing the PTAC Delegates to oppose these motions.  

 

PTAC Delegate Sean Bagbey and Nominating Committee member Jane Jackson led the Reps through a continuing education course titled, Everyone Communicates but Few People Connect, with a focus on developing leadership skills needed to more effectively influence the profession and society as a whole, and improve interactions with our patients, and through connecting with others using personal and interpersonal communication. 

 

PTA Caucus Reps spent time discussing #PTA10K, a newly-launched membership initiative to reach 10,000 PTA members. Plans were developed to take back to chapter leadership, specifically for what could be done at the state level to significantly move the needle on PTA membership. Student Assembly President Jeremy Curtis and Vice President Alex Dien joined the discussion with a focus on retention. While the Reps finished their discussions, Amy Smith, Chief Delegate, attended the Component Leadership Meeting with Chief-Elect David Harris. Amy presented the #PTA10K initiative to APTA leaders, and the entire Caucus briefly joined Amy during this time and added energy to the room as they collaborated with component leaders on how to initiate plans in their own chapters and sections to increase PTA membership and involvement. Brenda Dorman, Delegate, joined Florida Chapter President Jamie Dyson to talk about the #PTA10K virtual run – a collaborative event with the Florida Chapter and PTA Caucus to raise awareness about #PTA10K and raise money for APTA advocacy efforts. 

 

Representatives opted into joining one of four groups to talk about better partnership with APTA’s Education Leadership Partnership, building a stronger PTA community through communication, plans for celebrating the 50th anniversary of the PTA in 2019, and fostering leadership growth within the PTA Caucus. 

 

PTA Caucus Nominating Committee Chair Christina Wilson and Alternate Delegate Jimmy Pacini were recognized for their service. A tribute was paid to Chief Delegate Amy Smith after six years of service and brilliant leadership.


Spring 2018 PTA Update 

Submitted by: Lisa Stejskal, PTA, MAEd, NH APTA PTA Caucus (PTAC) Representative 

Since the PTAC annual meeting in June, members of the PTAC have been working steadily to move our goals forward in the spirit of collaboration across the Association, with an eye on opportunities where PTAs are invited to join important discussions.

APTA’s Educational Leadership Partnership (ELP) was assembled in 2017 to create a shared vision for PT clinical education and includes representatives from The American Council of Academic Physical Therapy (ACAPT), APTA, and the Education Section of APTA. A PTA sub-group was developed within the ELP; I am serving as a member of the sub-group representing the PTAC.

Using the PTA Caucus Strategic Plan as a guide in 2018, the work of the Caucus will continue to focus on engaging and empowering our Reps to be strong leaders, working alongside APTA to continue PTA member growth, and demonstrating the value of the PT/PTA team in practice. PTA Full Vote at the component level has passed in 37 states and 9 Sections, with 2 additional states pending.  PTAC Delegates have launched discussions on how to celebrate the 50th anniversary of the PTA in 2019, and a work group of five PTAC Reps was created to determine the feasibility of creating a Chief-Elect position within the Caucus to help with transitioning a new Chief and maintaining momentum.

Our PTA Caucus federal affairs liaison, Rachel Winthrop, provided the following update to the PTA Caucus in March 2018:

Regulatory Update

Federal agency meetings conducted in February

  • Home Health Technical Expert Panel: On February 1, 2018, APTA participated in an in-person home health technical expert panel (TEP) convened by CMS and Abt Associates in Bethesda, MD. The discussion focused on refinements and structural changes to the Medicare Home Health Prospective Payment System. The TEP evaluated all aspects of the payment system in an effect to identify changes that could align payment with high quality, appropriate care, ensure access to services for all beneficiaries, and reduce vulnerabilities.
  • APTA met with TRICARE to discuss implementation of the National Defense Reauthorization Act re: PTAs as authorized providers.
  • We, along with the other non-physician provider groups excluded from MIPS, met with CMS to discuss inclusion of non-physician practitioners within MIPS in 2019. We outlined our concerns and offered recommendations related to the low-volume threshold, certified EHRs, weighting of MIPS categories, and APM options for non-physician providers.
  • We are in the midst of scheduling a meeting with CMS to discuss APM development and the inclusion of physical therapists and other non-physician providers.
  • We also recently met with HHS Office of National Coordinator of Health IT regarding
    interoperability standards and incorporating standards applicable and related to physical
    therapy.

TRICARE program transition problems

  • We’ve heard from members in the TRICARE East and West regions that they are having significant issues as a result of the transition to new contractors/consolidation of regions, including:
    • Significant claims processing delays;
    • Providers receiving no payment to date for services furnished to TRICARE beneficiaries in January and February 2018; 
    • Due to the above, financially crippling consequences to those that treat a high volume of TRICARE patients; and
    • Also, Humana Military’s customer service representatives are providing few details as to what is causing the delays and when physical therapy practices may expect to receive payment.
  • APTA has apprised the Defense Health Agency of this information and the resulting negative financial impact and hardship to physical therapy practices. We’ve also spoken with members of the Armed Services Committee. The Defense Health Agency has informed APTA that it is working to address these issues and will keep APTA apprised of its progress. If you hear from members who are having problems with Health Net Federal Services or Humana Military, please contact or have the members contact, Kara Gainer at advocacy@apta.org.

Therapy Cap

Medicaid

  • Pursuant to the 21st Century Cures Act, providers who furnish items and services to FFS Medicaid, Medicaid managed care, and CHIP beneficiaries are required to enroll with their state Medicaid agency. The enrollment requirements for Medicaid and CHIP providers are effective as of January 1, 2017, and January 1, 2018 for providers in Medicaid managed care networks. APTA is finalizing a fact sheet that outlines the new requirements and will post it on our webpage in the coming days. We are encouraging all physical therapists to apply for a NPI and also check their state’s enrollment policies to determine their state Medicaid agency’s provider enrollment requirements, as states have some flexibility in who they are requiring to enroll. For more information: https://www.medicaid.gov/affordable-care-act/downloads/program-integrity/mpec6232017.pdf

Comment letters

  • APTA recently submitted comments to the Department of Labor on its Association health plan rule. APTA also recently submitted recommendations to Senate Finance Committee on opioids/pain management; we also will be submitting a comment letter to the House Ways and Means Committee on the same topic by March 15, 2018.
  • APTA will be submitting comments on the short-term limited duration insurance proposed rule. This is in response to Trump’s Executive Order instructing HHS, Labor, and Treasury to consider proposing or revising guidance related to short-term limited duration insurance. The proposed rule would change the maximum duration of such coverage to less than 12 months, as opposed to the current maximum duration of less than three months. Short-term, limited-duration insurance is a type of health insurance coverage that is designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another form of coverage. This type of coverage is exempt from the definition of individual health insurance coverage under the Affordable Care Act (ACA) and is therefore not subject to the ACA provisions that apply to individual health insurance plans.
  • APTA will be submitting comments on the proposed delay of the Equity in the Individuals with Disabilities Education Act rule, which addresses disproportionate identification, placement, and disciplinary treatment of students of color in special education. The Department of Education is proposing to postpone the compliance date by two years, from July 1, 2018, to July 1, 2020. The Department also proposes to postpone the date for including children ages three through five in the analysis of significant disproportionality with respect to the identification of children as children with disabilities and as children with a particular impairment from July 1, 2020, to July 1, 2022. The purpose of the delay is to allow the Department to ensure the regulation effectively addresses significant disproportionality. To view the proposal: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-04102.pdf
  • APTA will be submitting comments in response to the USDA and HHS’s request for comments on the topics and scientific questions to inform their development of the 2020- 2025 Dietary Guidelines for Americans. Public comments can be submitted here: https://www.dietaryguidelines.gov/
  • APTA will be submitting comments to the Agency for Healthcare Research and Quality in response to a request for information. Information is being solicited to inform the agency’s work on patient-reported outcomes (PROs). Access to information regarding physical function PRO measure use will assist the selection of measures for AHRQ’s efforts to develop and implement user-friendly technical tools to collect and integrate PRO data in electronic health records or other health information technology products. https://s3.amazonaws.com/public-inspection.federalregister.gov/2018- 04050.pdf?utm_campaign=pi%20subscription%20mailing%20list&utm_source=federalr egister.gov&utm_medium=email

Congressional Update

  • One of the biggest issues discussed in Congress right now is the opioids epidemic. Right now, Ways and Means, Energy and Commerce, Senate HELP and Finance Committees are all holding hearings and both chambers intend to bring comprehensive packages to the House and Senate floors later this year.
  • We have been making the rounds and talking to key committees and legislative staff to make sure they know that PTs are part of the solution. I have been discussing the importance of educating providers and consumers of the role PTs play and reducing barriers through regulatory reform.
  • The meetings and the hearings are all ongoing and as each committee dives deeper into the process, I will certainly update everyone on the next call.
  • Next, regarding TRICARE, APTA had a meeting in early Feb with them here in DC.
  • It was a productive meeting and they were very forthcoming with information regarding the timeline of implementation of the PTA change.
  • We were told it will need a proposed rule, which will be released sometime in the fall of 2018 or early spring of 2019. There will be a 60-day comment period. Once this rule is released we will have a much better idea of the timeline on this.
  • Additionally, there are several factors that could impact the length of this process, from time it takes departments to review the rule to even a change in administration. We are pushing members of Congress and contacts we have within agencies to help us get it on top of the pile.
  • We know this will not be retroactive and TRICARE does not consider PTAs as a covered provider until the rule is finalized (and even then, it may take another month for the contractors to implement).
  • Finally, we are working to find out the scope and priorities of this year’s national defense authorization act to see if there are opportunities for us again.
  • Congress doesn’t have their next break until Easter, so the congressional affairs team will keep pushing on our issues and monitoring what is happening on the hill.
  • House of Representatives have written the higher education act reauthorization bill known as the PROPSER Act. APTA is working with four other groups to get rid of a capped aggregate loan amount a student can take out from the federal government, to get rid of the graduate loan amount they would cap at 28,500 a year, and other provisions. These are similar to what was in the original House Tax bill in late 2017 and were taken out due to the excessive emails, calls, and letters they received. APTA is currently discussing this with the appropriate Senate members and will keep you apprised to the state of the bill.

Therapy Cap

Congress passed The Bipartisan Budget Act of 2018 that funds the US government through March 23, 2018 and sets the spending framework for 2019. President Trump signed the budget deal into law at approximately 8:30 am. This deal increases both military and domestic spending, and addresses disaster relief along with a host of critical federal health programs, including a permanent fix to the Medicare Part B hard therapy cap.

As you know a permanent fix to the hard therapy cap has been an APTA priority issue since the cap was first established in 1997. Over the past 20 years, Congress recognized the cap was a flawed policy and thus enacted a series of moratoria and an exceptions process to delay or prevent its implementation. On January 1, 2018, when the hard cap was applied, patients felt the brunt of what happens when Congress fails to act. The legislation enacted today is a permanent solution to the hard cap and forever eliminates the constant threat it posed to patients. The budget deal also includes provisions that APTA does not support. At the top of this list is the provision to reduce payment for services in which a physical therapist assistant (PTA) is involved under Medicare Part B. Beginning January 1, 2022, payment for services provided by a PTA, as well as services provided by an occupational therapy assistant (OTA), would be paid at 85% of the Medicare fee schedule.

Congressional rules require certain policies to be linked to other policies known as “pay-fors” at the time that the policy change is proposed. The cost of a permanent fix to the therapy cap was estimated at $6.47 billion. On Monday night, February 5, the House of Representatives released its proposed package, which included a last-minute addition of a PTA and OTA payment differential. This policy was not part of any of the discussions or negotiations on Capitol Hill over the past year, nor was it included as part of the proposed package of pay-fors that were announced this past fall as part of the bipartisan, bicameral agreement. On Tuesday, February 6, APTA and our allies responded with alternative proposals to eliminate, reduce, or delay the PTA and OTA payment differential. Each of these legislative options was rejected.

Inclusion of the PTA and OTA payment differential as part of the deal does not mean the fight is over. Although this provision was included we may have the ability to influence the payment differential during the regulatory process. The next step is for the Centers for Medicare and Medicaid Services (CMS) to develop proposed rules to further define and provide additional guidance prior to implementation. APTA will leverage its congressional champions, the APTA Public Policy and Advocacy Committee, and the PTA Caucus on strategies to address the CMS activities. Our collective efforts will drive the association’s work to ensure that guidance to implement the new policy is favorable to PTAs and the profession, while assuring access is not limited for those in need of our services.

The legislation enacted provides a fix for the hard therapy cap by permanently extending the current exceptions process, eliminating the need to fix this issue from year to year. Therapy claims for outpatient Medicare Part B that go above $2,010 (adjusted annually) will still require the use of the KX modifier for attestation that services are medically necessary. The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027. While the threshold amount for medical review will be lowered, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase. Claims that go above $3,000 will not automatically be subject to targeted medical review; only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.

The budget deal also incorporates items that impact home health. On the positive side it includes an extension of the home health rural add-on at current levels for 2018; it also includes varied add-on rates for rural counties from 2019 through 2022. Additionally, it includes a provision allowing home health medical records to be used to determine eligibility for home health services. It also requires the FY 2020 market basket update for home health agencies to increase by 1.5% in 2020. However, on the flip side it requires a budget-neutral transition to a 30-day unit of service for home health services, down from the current 60-day unit of payment starting in 2020 and eliminates the use of therapy thresholds in case-mix adjustment factors. It also includes a requirement to convene at least one session of a technical expert panel to identify and prioritize recommendations for the revised payment system. Finally, it requires HHS to undergo rulemaking to propose and then finalize the revised payment system prior to January 1, 2020. As this was a comprehensive bill addressing multiple issues, many pay-fors were included to offset spending.

APTA hosted a special edition of Insider Intel for our members that focused on additional details and frequently asked questions related to the Bipartisan Budget Act of 2018 signed into law on February 9. The budget deal included a permanent fix to Medicare’s hard cap on outpatient therapy services, PTA/OTA payment differential, changes to the home health payment system, funding for CHIP, and more. To view the recording please click on the following link: http://apta.adobeconnect.com/p6s2l189ckli/

As always it is my pleasure to serve the NHAPTA chapter as PTA Caucus Representative.  My role is to represent physical therapist assistants, as well as the needs of the PT/PTA teams within our state.  NH APTA Board Members will soon be traveling around to various NH clinics and present current issues of interest happening legislatively at the state and national level along with discussing motions to be presented at the APTA House of Delegates (APTA governing body) in June 2018.  Your input to these discussions are valued.  Anyone is welcome to attend any of the caucuses.  For further information please go to the NHAPTA website:  https://www.nhapta.org/About-Us/NH-APT-Spring-Caucuses/ .  We hope to meet as many of you as we can. 

Additionally, hearing from you helps me tremendously, so please "help me, help you"!  Feel free to contact me at l.stejskal@yahoo.com , if you have any questions or concerns. 

 

 APTA

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