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COVID-19 General Resources
General and Targeted Distribution Provider Relief Fund Post-Payment Notice of Reporting Requirements
On July 21, the U.S. Department of Health and Human Services (HHS) released a framework for more detailed Provider Relief Fund (PRF) reporting guidance and materials to be released on August 17, 2020. In the short, two-page document, HHS reiterates the reporting requirements included in the Terms and Conditions (T&Cs) providers had to attest to as part of the funding award process.
These reporting instructions will provide directions on reporting obligations applicable to any provider that received one or more payments exceeding $10,000 in the aggregate from the PRF.
The reports will allow providers to demonstrate compliance with the T&Cs, including use of funds for allowable purposes, for each PRF payment. HRSA plans to provide recipients with Question and Answer (Q&A) Sessions via Webinar in advance of the submission deadline. Additional details will follow regarding the Q&A Sessions.
HHS also provides dates for reporting. The reporting system will become available to recipients on October 1, 2020. All recipients must report within 45 days of the end of calendar year 2020 on their expenditures through the period ending December 31, 2020. However, recipients who have expended funds in full prior to December 31, 2020 may submit a single final report at any time during the window that begins October 1, 2020, but no later than February 15, 2021. Recipients with funds unexpended after December 31, 2020 must submit a second and final report no later than July 31, 2021.
CMS posted an updated set of Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) billing during the COVID-19 public health emergency (PHE).
The FAQs outline policies for Medicare-covered items and services that are in effect “for the duration of the public health emergency, unless superseded by future legislation.” The agency adds that it is “thoroughly assessing” legislation passed by Congress, including the CARES Act, and will issue updated FAQs “as implementation plans are announced.”
Updated FAQs address multiple provider, item and service categories, including: diagnostic laboratory services, hospital outpatient services, partial hospitalization services, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), Medicare-covered telehealth services, scope of practice issues, teaching physician regulations, the Medicare Shared Savings Program, Opioid Treatment Programs, Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, Home Health Agencies, and durable medical equipment.
COVID19 Pandemic and the Physical Therapy Practice
Yesterday, the Department of Health and Human Services (HHS) posted an updated set of FAQs regarding the Provider Relief Fund established as part of the CARES Act to support health care providers during the COVID-19 pandemic. The newly added FAQs address: the new Provider Relief Fund for eligible Medicaid and CHIP providers; accounting for prescription drug sales with respect to the General Distribution to Medicare providers; the Medicaid and CHIP Targeted Distribution announced on Tuesday; and the Safety Net Hospitals Distribution announced yesterday. The following are among the updates issued by HHS:
Provider Relief Fund Payment Portal - HHS provides new information, including the following: the new Provider Relief Fund Payment Portal will initially be used for new submissions from Medicaid and CHIP providers seeking payments under the Provider Relief Fund beginning June 10, 2020, and is open to providers who received Medicaid and CHIP payments in 2017 through 2020 and who have not received any payments from the $50 billion Provider Relief Fund General Distribution.
Medicaid Targeted Distribution - HHS provides details about the process and requirements for the Medicaid and CHIP Targeted Distribution, including: (1) clarifying that providers who received payments in the prior $50 billion General Distribution payment are not eligible to receive payment in this current Medicaid Targeted Distribution; however, providers who received a "Targeted Distribution" payment — such as the High Impact Area, Rural, Indian Health Service, and Skilled Nursing Facility Targeted Distributions — could be eligible; (2) providing a detailed list of requirements for eligibility, including the requirement to have "directly billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019, or (ii) own (on the application date) an included subsidiary that has billed Medicaid for healthcare-related services during the period of January 1, 2018, to December 31, 2019; (3) explaining that payments will be made to providers on the filing TIN list submitted by states to CMS, with HHS using an "additional process to validate eligibility" for providers not on the filing TIN list; (3) establishing a deadline of July 3, 2020 to submit an application for the Medicaid Targeted Distribution; and (4) stating that payments will be disbursed "on a rolling basis."
HHS also posted Terms and Conditions applicable to the Medicaid and Safety Net Hospitals Targeted Distributions. Additional information can be found in the attached HHS materials and at: https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/index.html.
- HHS 6 10 2020 Provider Relief Fund General Distribution FAQs
- Terms and Conditions Medicaid Relief Fund
PTAs Will be Authorized TRICARE Providers Beginning Mid-April
Effective April 16, 2020, TRICARE has approved Physical Therapy Assistants (PTA) and Occupational Therapy Assistants (OTA) as TRICARE-authorized providers under the supervision of a TRICARE-authorized, licensed and registered physical therapist or occupational therapist in accordance with Medicare's rules for supervision and qualification.
Per TRICARE guidelines, PTAs and OTAs may not:
- Provide an initial examination
- Provide an evaluation
- Provide a re-evaluation and/or assessment
- Establish a diagnosis
- Establish a plan of care
When submitting claims, please follow these guidelines:
- Use the CQ modifier when submitting claims for services performed in whole or in part by a PTA
- Use the CO modifier when submitting claims for services performed in whole or in part by an OTA
ACAPT has developed some new guidelines for PT education programs during this COVID-19 period and potentially beyond. The docs are included at: ACAPT's Response to the COVID-19 "New Normal" and cover:
- Returning to the PT classroom & lab
- Needs of DPT class of 2020
- Guidance on participation in CE experiences
NRHA and Small Business Administration Present: "Rural Providers and the Paycheck Protection Program" (Kara Gainer, JD)
From: Kara Gainer, JD
This week, NRHA and the U.S. Small Business Administration (SBA) partnered to host a series of regional webinars to highlight Paycheck Protection Program (PPP) funding available to support America's rural healthcare providers, titled, "Rural Providers and the Paycheck Protection Program." NRHA and SBA will be hosting two additional webinars next week.
There are still funds in the PPP, and there is potential for more funds to be appropriated for this program in forthcoming relief packages. Don't miss this opportunity. We strongly urge rural providers to apply to the PPP and save the dates of these important webinars. For all the webinars listed below, you will be able to use a live streamed link and/or join the call by phone. Register using the links below!
Tuesday, May 19th
SBA Regions 2 & 3
SBA Regional Administrator, Steve Bulger
New York, New Jersey, Puerto Rico, and the US Virgin Islands, DC, Maryland, Pennsylvania, Virginia, and West Virginia
Time: 10:00-11:00 AM EDT
Click here to register
SBA Region 10
SBA Regional Administrator, Jeremy Field
Washington, Alaska, Oregon, Idaho
Time: 9:00-10:00 AM PDT
Click here to register
The webinar format includes presentations by NRHA and SBA with an opportunity for questions and answers for both current loan recipients as well as those who have not yet applied. Please log in or dial in to learn more information on the PPP and to hear from:
- Maggie Elehwany, Vice President of Government Affairs and Policy, National Rural Health Association and Brock Slabach, Senior Vice President of Member Services, National Rural Health Association
- Dan Nordberg, Director, Office of Rural Affairs and Regional Administrator, U.S. Small Business Administration
- SBA Regional Leadership
- Additionally, the recordings of the first six webinars are listed below:
Telemedicine is acceptable in the practice of physical therapy in New Mexico. This comes from the NM Telemedicine Act. Telemedicine and telehealth are acceptable forms of practice for physical therapists and PT-Supervised physical therapist assistants in New Mexico.
Please expect more clarification from the Physical Therapy Board in coming days.
Click here (Article 25) for information about the Telemedicine Act (also referred to as the Telehealth Act).
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Latest Relief Package: Options for Small Businesses
The CARES Act signed into law on March 27 is aimed at providing relief in a wide range of areas in response to the COVID-19 pandemic. Here's what the package offers to small businesses.
The federal government has acknowledged that small businesses may be especially hard hit by the COVID-19 pandemic and has responded by establishing provisions aimed at lessening some of the impact. The latest measure, known as the CARES Act, includes some of the most extensive small business relief to date. Here's an overview of the small business-related relief provisions in the CARES Act.
Details on these provisions, as well as on other pandemic-related resources, are available from the U.S. Small Business Administration, the U.S. Chamber of Commerce, the U.S. Department of the Treasury, and the Internal Revenue Service.
Paycheck Protection Program Loans
The legislation creates the Paycheck Protection Program, a new loan product within the Small Business Administration's 7(a) Loan Program. Existing and new SBA lenders will be able offer these loans to eligible small businesses.
The new loan, with an interest rate of up to 4%, will be 100% guaranteed by the SBA. Funds may cover payroll costs, including continuation of group health care benefits during periods of paid sick, medical, or family leave, and insurance premiums; employee salaries and commissions; payments of interest on any mortgage obligation, rent, and utilities; and interest on any other debt obligation incurred before February 15, 2020.
Businesses and charitable nonprofits with fewer than 500 employees, sole proprietors, independent contractors, and self-employed individuals are eligible for the loans.
A business can borrow up to 2.5 times the average monthly payroll based on the business's prior year's payroll, capped at $10 million. All borrower and lender fees for Paycheck Protection loans will be waived, as well as collateral requirements, the Credit Elsewhere Test, and all requirements for personal guarantees. Deferrals of principal, interest, and fees for six months will be built into the loans. Click HERE for an FAQ on page 5.
The CARES Act signed into law on March 27 is aimed at providing relief in a wide range of areas in response to the COVID-19 pandemic. Here's what the package offers to small businesses.
Emergency Economic Injury Grants
The CARES Act allows $10,000 of SBA economic injury disaster loans (EIDLs) to be provided to small businesses and nonprofits without a requirement for repayment. EIDLs are loans of up to $2 million that carry interest rates up to 3.75% for companies and up to 2.75% for nonprofits, as well as principal and interest deferment for up to four years. The loans may be used to pay for expenses that could have been met had the disaster not occurred, including payroll, paid sick leave to employees, increased production costs due to supply chain disruptions, and business obligations, including debts, rent and mortgage payments.
The $10,000 grant portion of an EIDL does not need to be repaid, even if the grantee is subsequently denied an EIDL for amounts beyond the $10,000. Eligible grant recipients must have been in operation on January 31, 2020. The grant is available to small businesses, private nonprofits, sole proprietors and independent contractors, tribal businesses, as well as cooperatives and employee-owned businesses.
The relief package establishes that the borrower of an SBA loan is eligible for loan forgiveness equal to the amount spent by the borrower on payroll costs, interest payment on any mortgage incurred prior to February 15, 2020, payment of rent on any lease in force prior to February 15, 2020, and payment on any utility for which service began before February 15, 2020. The loan forgiveness period extends to eight weeks after the origination date of the loan.
Debt Relief for Existing and New SBA Borrowers
The stimulus package includes $17 billion to provide immediate relief to small businesses through standard SBA 7(a), 504, or microloans. Under this provision, SBA will cover all loan payments for existing SBA borrowers, including principal, interest, and fees, for six months. This relief will also be available to new borrowers who take out an SBA loan within six months after March 27, 2020.
The measure also encourages banks to provide further relief to small business borrowers by allowing them to extend the duration of existing loans beyond existing limits, and enables small business lenders to provide a temporary extension on certain reporting requirements for new and existing borrowers. While SBA borrowers are receiving the six months of debt relief, they also may apply for a Paycheck Protection Program loan that provides capital to keep their employees on the job. Borrowers may not apply the six months of SBA payment relief to Paycheck Protection loan payments.
Employee Retention Credit for Employers Subject to Closure due to COVID-19
The CARES Act provides a refundable payroll tax credit for 50% of wages paid by employers during the COVID-19 crisis. The credit is available to employers whose operations were fully or partially suspended due to a COVID-19-related shut-down order, or whose gross receipts declined by more than 50% compared with the same quarter in the prior year.
For employers with greater than 100 full-time employees, the credit is based on wages paid to employees while they are not providing services due to the COVID-19-related circumstances described above. For eligible employers with 100 or fewer full-time employees, all employee wages qualify for the credit, whether the employer is open for business or subject to a shut-down order. The credit is provided for the first $10,000 of compensation, including health benefits, paid to an eligible employee between March 13, 2020, and December 31, 2020.
Delay of Payment of Employer Payroll Taxes
The stimulus package allows employers and self-employed individuals to defer payment of the employer share of the Social Security tax on employee wages. The provision allows for half of the amount to be paid by December 31, 2021, and the other half by December 31, 2022.
Modification of Limitation on Losses for Taxpayers Other Than Corporations
This provision of the act modifies the loss limitation applicable to pass-through businesses and sole proprietors, so they can use excess business losses to access critical cash flow.
Modification of Limitation on Business Interest
The relief legislation temporarily increases the amount of interest expense businesses are allowed to deduct on their tax returns from 30% to 50% of taxable income (with adjustments) for 2019 and 2020. This provision allows businesses to increase liquidity with a reduced cost of capital.
Modifications for Net Operating Losses
Net operating losses are typically subject to a taxable income limitation, and they cannot be carried back to reduce income in a prior tax year. The legislation allows a net operating loss arising in a tax year beginning in 2018, 2019, or 2020 to be carried back five years. The provision also temporarily removes the taxable income limitation to allow an NOL to fully offset income. These changes will allow companies to amend prior year returns to take advantage of operating losses.
Wednesdays, July 22 - September 23, 2020
HHS Telemedicine Webinar
CMS has announced that outpatient therapy furnished via telehealth can be reported on institutional claim during COVID-19 PHE in its updated coronavirus waiver FAQs.
CMS has updated it's coronavirus waivers FAQs to add a new section on outpatient therapy and telehealth. Please find below the 3 new FAQs:
Question: Can outpatient therapy services that are furnished via telehealth and separately paid under Part B be reported on an institutional claim (e.g., UB-04) during the COVID-19 PHE?
Answer: Yes, outpatient therapy services that are furnished via telehealth, and are separately paid and not included as part of a bundled institutional payment, can be reported on institutional claims with the "-95" modifier applied to the service line.
- Hospital - 12X or 13X (for hospital outpatient therapy services);
- Skilled Nursing Facility (SNF) - 22X or 23X (SNFs may, in some circumstances, furnish Part B physical therapy (PT)/occupational therapy (OT)/speech-language pathology (SLP) services to their own long-term residents);
- Critical Access Hospital (CAH) - 85X (CAHs may separately provide and bill for PT, OT, and SLP services on 85X bill type);
- Comprehensive Outpatient Rehabilitation Facility (CORF) - 75X (CORFs provide ambulatory outpatient PT, OT, SLP services);
- Outpatient Rehabilitation Facility (ORF) - 74X (ORFs, also known as rehabilitation agencies, provide ambulatory outpatient PT & SLP as well as OT services); and
- Home Health Agency (HHA) - 34X (agencies may separately provide and bill for outpatient PT/OT/SLP services to persons in their homes only if such patients are not under a home health plan of care).
Question: Can therapy services furnished using telecommunications technology be paid separately in a Medicare Part A skilled nursing facility (SNF) stay?
Answer: Provision of therapy services using telecommunications technology (consistent with applicable state scope of practice laws) does not change rules regarding SNF consolidated billing or bundling. For example, Medicare payment for therapy services is bundled into the SNF Prospective Payment System (PPS) rate during a SNF covered Part A stay, regardless of whether or not they are furnished using telecommunications technology. Therapy services furnished to a SNF resident, whether in person or as telehealth services, during a non-covered SNF stay (Part A benefits exhausted, SNF level of care requirement not met, etc.) must be billed to Part B by the SNF itself using bill type 22X, regardless of whether or not they are furnished using telecommunications technology.
Question: Can outpatient therapy services be furnished and paid separately for patients receiving Medicare home health services?
Answer: No. For patients under a home health plan of care, payment for therapy services (unless provided by physicians/non-physician practitioners) is included or bundled into Medicare's payment to the HHA, and those services must be billed by the HHA under the HHA consolidated billing rules. Patients should first be assessed for whether they are eligible to receive therapy services under the home health benefit prior to initiating outpatient therapy services. Receiving therapy services under the home health benefit may be in the best interest of the patient as there is no applicable coinsurance, copay, or deductible for such services (with the exception of negative pressure wound therapy using a disposable device), and the patient may also have a need for skilled nursing services, home health aide services, or medical social services under the home health benefit. However, if the patient is not eligible for home health care, including when it is not possible to provide in-person therapy services in the patient's home (i.e., the patient is not under a home health plan of care), then outpatient therapy furnished via telehealth under Part B could be an appropriate alternative and separately billed, assuming all applicable requirements are otherwise met.
Questions? Reach out at [email protected]
Check on the Status of State Emergency Mandates and Payers Allowing Telehealth
As things rapidly develop regarding the COVID-19 pandemic, mandates and payer policies around telehealth are continuously evolving. APTA has developed a series of summaries of the status of federal, state, and commercial payers regarding eligibility of PTs to provide telehealth services and payer coverage of some form of telehealth during the COVID-19 pandemic, based on information the states and payers have released. APTA will update these resources weekly with new information that has been confirmed. These are summaries only; refer to the payer policies and state laws for the most accurate and current information.
- Federal Payer Telehealth Coverage
- Commercial Payer Telehealth Coverage
- State-Related Actions Related to Nonfederal Payers
- State Actions Permitting PTs To Provide Telehealth
- Occupational Medicine Providers Telehealth Coverage
As federal guidelines continue to evolve in support of the COVID-19 pandemic, Cigna is adopting a position consistent with the federal public health emergency period, which ends on July 24, 2020. As such, Cigna is extending the customer cost-share waivers and other enhanced benefits, including our interim virtual care policy, through at least July 31, 2020.
Q: Will Cigna allow for physical therapists to provide virtual care?
A: Yes. PT providers can now deliver virtual care for any service that is on their current fee schedule. We have removed the previous guidance that CMS also had to cover the service virtually. PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and a face-to-face place of service code (e.g., POS 11).
Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier.
- While we encourage PT providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time.
- We maintain all current medical necessity review criteria for virtual care at this time.
- Our national ancillary partner American Specialty Health (ASH) is applying the same virtual care guidance, so any provider participating through ASH and providing PT/OT services to Cigna customers is covered by the same guidance.
- CMS: Potential Flexibility for Hospital Outpatient Department PTs and PTAs in Care Delivery; PTAs can Furnish Telehealth in Private Practices
- COVID-19 Guidance for Centennial Care 2.0 MCOs
- State of NM Office of Superintendent of Insurance - Utilization and Reimbursement of Telemedicine During COVID-19 Pubic Health Emergency
- COVID-19 and NM Medicaid
- A Message From the NMAPTA President and Practice & Payment Chair
CMS published an Interim Final Rule that included new information related to PT/OT/SLP providing both telehealth and E-visits.
Telehealth: At this time it is not approved for therapy with Medicare Part B.
E-Visits: In this rule they inserted the word "private practice" therapist—which is being interpreted as those therapists in private practice only, and NOT hospital based OP therapy. Because of this, there is now uncertainty as to whether a hospital based therapist can perform e-visits and be reimbursed when billing through a UB04.
It is the recommendation of the APTA that we contact our MAC to determine whether e-visits will be covered. Please do so, and confirm in writing, prior to initiating these services.
Here is the response received from the APTA:
"Based on the interim final rule released last night, CMS described these as 'sometimes therapy' services that require the private practice PT to include the GP modifier on the claim. Given this statement and reference to 'private practice' therapists, it is unclear whether institutional settings can bill e-visits. As we continue to seek clarification from CMS, we encourage providers to check with your Medicare Administrative Contractor. We also anticipate CMS will be releasing additional guidance in the very near future that will hopefully address this question once and for all."