Clarice Grote, MS, OTR/L

Clarice Grote, MS, OTR/L

Are You Ready for When the Public Health Emergency Ends?

No one can deny that the COVID-19 pandemic has been detrimental to our healthcare system and society. However, the opportunities provided under the COVID-19 Public Health Emergency (PHE) has provided a unique opportunity to trial innovative care models through temporary waivers.

Many of these waivers impact occupational therapy and the types of services we can and cannot provide. This is especially true for Medicare. The PHE may also have impacted your state license, CEU requirements, and so much more.

The COVID-19 PHE was initially activated on January 31, 2020. Well.. almost exactly three years later, the White House announced on January 30, 2023, that the COVID-19 PHE will officially end on May 11th.

Topics Discussed in this Article

Telehealth

CMS added OT, PT, and SLP billing codes to the eligible codes for telehealth. They later added OT, PT, and SLPs as eligible providers of telehealth under Medicare in a PHE waiver. However, this change is not yet permanent as it requires action from Congress. Meaning, CMS is not allowed to add telehealth therapy services as a covered Medicare service in the rule-making process.

Congress did pass legislation that would initially would extend this waiver 151 day after the expiration of the COVID-19 PHE. However, thanks to continued advocacy from AOTA and other healthcare leaders, Congress passed additional legislation at the end of 2022 that expands Medicare’s coverage of telehealth therapy services until the end of 2024.

A permanent solution is still needed, but at least this gives some temporary coverage. Stay tuned for further legislation to be introduced in the 118th Congress. You can learn more about current advocacy initiatives from AOTA at www.aota.org/take action.

SNF 3-Day Prior Hospitalization Requiment

CMS temporarily waived the SNF admission requirement of a 3-day prior hospitalization. This temporary coverage of SNF services applied to people who experienced dislocations or were otherwise affected by COVID-19.

CMS also allowed some beneficiaries to renew SNF coverage without the start of a new benefit period but only for those whose care was delayed or prevented by their ability to end their current benefit period. Meaning, without the COVID-19 pandemic, their benefits would have renewed under normal circumstances.

These flexibilities end when the PHE ends.

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Home Health OASIS

CMS allowed OT to initiate the OASIS for the first time ever during the COVID-19 PHE. CMS granted temporary flexibilities allowing PT, SLP, and OT to initiate the initial and comprehensive assessment in traditional home health for Medicare patients even when nursing is involved. Since that time, Congress passed the Consolidated Appropriates Act of 2021, which included the language of the Medicare Home Health Flexibility Act.

So, although this flexibility will end once the PHE expires, OTs will continue to be able to initiate the initial and comprehensive assessment for Medicare Part A patients but in therapy-only cases. Meaning, skilled nursing is not included on the initial order. Be careful of misinformation on this one! To help you advocate more effectively, I put together this article for you complete with quotes from the Conditions of Participation proving OTs can initiate the comprehensive assessment in home health cases. Check it out HERE!

OTA/PTA Supervision

Prior to the COVID-19 PHE, Medicare required “direct supervision” for occupational therapy assistants and physical therapist assistants in private practice for Medicare Part B. This provision does not apply to all Part B settings – only those in private practice. So if you work in outpatient, mobile part B, etc., that isn’t part of a hospital, then this applies to you. Direct supervision requires that the OT/ PT be in the building and on-site to provide supervision which is obviously limiting for many practices, especially in mobile practices and rural areas.

Under the COVID-19 PHE, Medicare provided a waiver to allow “general supervision”. Meaning, the OT/PT just had to be available to the OTA or PTA virtually or in person. AOTA did initiate advocacy efforts as part of the SMART Act to permanently change the supervision language in the Chapter 15 Medicare Benefit Policy Manual. However, this provision was not included in the end of year 2022 legislation. Keep an eye out for this legislation to be re-introduced in the coming months.

Maintenance Therapy

CMS issued a waiver allowing OTs and PTs to delegate maintenance therapy plans to OTAs and PTAs. This flexibility was permanently adopted in the CY 2021 Medicare Physician Fee Schedule rulemaking. So, OTs and PTs can now utilize OTAs and PTs to carry out maintenance therapy services as they would a rehabilitation service. Prior to this, only OTs and PTs could provide maintenance therapy to Medicare patients.

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COVID-19 Care Coverage

Under the PHE, millions of Americans have received free COVID tests and care. Once the PHE ends, an individual’s ability to receive free tests, vaccines, and care related to COVID-19 will depend on their health insurance plan. Additionally Medicare will discontinue increased payment rates for COVID patients.

COVID Tests

According to the New York Times, individuals on private insurance and Medicare could receive up to 8 free tests a month, even when administered by providers outside their network. Additionally, it was required that care be covered without cost-sharing and prior authorizations. We can expect that to no longer be the case in the future.

Vaccines and Antivirals

Individuals on private insurance, Medicare, and Medicaid will continue to receive COVID-19 vaccinations for free. However, those who are uninsured may need to pay out of pocket. When it comes to antivirals like Paxlovid, there are no requirements that this treatment is covered under any insurances. Much is yet to be determined about coverage of care related to COVID-19, but this is something to consider for ourselves and our patients.

Medicaid

Another popular waiver that carries big impacts is that states could keep individuals on Medicaid for as long as the PHE was active. The Federal Government provided additional funding to states to support the additional individuals on Medicaid. However, states have already begun preparations to remove individuals from Medicaid after legislation passed requiring this provision and funding to end in April regardless of if the PHE ended. Hopefully, this will ease the transition, but you may see fewer clients covered under Medicaid than the last couple of years and if your client is on Medicaid, it maybe good to double-check their status around April/ May.

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Resources

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hi there,

I’m  Clarice

Occupational therapist & medicare specialist helping practitioners understand policy, engage in advocacy, and own their value!

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