Insurance Companies deny therapy to children for PT/OT/ST during global COVID-19 pandemic.
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BCBS / UHC / Cigna / and Aetna are denying coverage for their beneficiaries to participate in telehealth in the therapy sector for occupational therapy, physical therapy, and speech therapy. We need your help to start the change needed so children can continue with their treatment plans while quarantined and social distancing. Please consider signing our petition.
In several counties we have been told to shut down businesses due to widespread cases of COVID-19 being reported. According to the newly released CDC guidelines, the President of the United States, as well as state and local officials have stated that we are to immediately implement social distancing and to avoid any gatherings of 10 people or more. Many clinics have more than 10 employees. This alone exceeds the CDC recommendations. We are completely unable to provide traditional in person therapy and are being advised by our therapy governing bodies and officials to move all therapy services to telehealth. There are a number of reasons why we believe that Insurance companies should be pro-actively working to help small businesses and other businesses overcome the hurdle of being reimbursed by insurance providers for all telehealth services. We are being told by BCBS / UHC / Cigna / Aetna that they will not allow all plans to accept and reimburse for Occupational Therapy, Speech Therapy, and Physical Therapy services due to CMS Guidelines. However as of 12:12 pm on 3/17/20 the following presser was released:
"The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country."
“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit the risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”
On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19)."
This expansion of these CMS rules (which all private insurance carriers follow) should immediately, and retroactively, be applied to the therapy sector during the time the government recommends as many as possible work from home and for which telehealth has been applied as a therapy modality. This should absolutely include therapists across the country to provide continued therapy services for our most vulnerable populations that cannot risk receiving therapy in person. Additionally, employers cannot risk the safety and well-being of their staff during this serious COVID-19 outbreak.
Please see the following reasons for why we believe we should be reimbursed for services rendered via telehealth and that all insurance carriers should allow their beneficiaries therapy benefits to apply to telehealth during this global pandemic:
#1 As therapists we are required by our state licensing by-laws to never under any circumstances perform patient abandonment. Yet the government and insurance companies are implementing and enforcing strict rules and guidelines so that we are unable to provide much needed healthcare to our patients. Therapy is an essential and medically necessary need for many patients.
#2 Abandoning children and other patients without the ability to continue our plan of care will cause potential harm, a regression of skills required for activities of daily living and basic skills such as speaking, safely eating/drinking, walking, and being independent in self-help skills. This would directly impact the significant progress that they have worked so hard to achieve with direct guidance and support from their therapist. These patients would require additional care and will have to start their therapy plans completely over when this pandemic ends so that they can regain skills within functional limits for activities of daily living.
#3 Telehealth and telerehab are proven and accepted therapy modalities that are occuring in real time through various platforms. Telehealth is provided via one on one therapy with our patients. This is within our scope of practice and ability of care. Our governing bodies for therapy, ASHA, AOTA, APTA, TOTA, TPTA, and TSHA have all encouraged therapy providers to utilize teletherapy during this difficult time for our country, where social distancing is our only option to stay safe.
#4 We see children with diagnoses whose health will be severely and directly impacted by this limitation as many of them are immunocompromised. These patients are more susceptible to COVID-19 at a greater risk than the general population.
** Feeding therapy patients suffer from silent aspiration on foods and liquids which can lead to pneumonia. Without regular parent training and therapy regarding proper positioning and techniques, these children are at an immediate greater risk of infection, which then increases the risk of complications from COVID-19.
** Patients with speech and/or language deficits will no longer have a trained therapist on their side assisting them in improving their overall communication skills and quality of life. Their families may have difficulty understanding their basic wants and needs due to the lack of continued therapy.
** Children with muscular spasticity due to cerebral palsy and/or other genetic anomalies need to participate in individualized therapeutic stretching/exercise protocols that are monitored and updated by skilled licensed therapists on a regular basis. Through telehealth, therapists are able to teach parents how to perform these specialized stretches in the home environment while interacting with a skilled licensed therapist to guide them through proper techniques to avoid any harm to the patients.
** Patients that struggle with emotional dysregulation who have made great progress with therapy at our clinic. If we can’t continue our plan of care with their families via telehealth, our patients would experience a regression of coping skills and would revert to negative behaviors impacting their daily lives and mental health.
** Many patients suffer from muscle weakness and poor coordination. With the help of continued guidance and support from skilled licensed therapists through the telehealth option, we can provide continuous activities that will improve their skills on a weekly basis rather than allowing for regression of skills to occur.
** Babies with torticollis (or a head tilt often accompanied by flattening of the head and facial asymmetry) would experience significant deficits in every area of life. Their vision, facial, head, and neck symmetry, gross and fine motor skills would all be negatively impacted by lack of therapy and parent education. These deficits which are easily treated with physical and occupational therapy, would linger later into their lives which is medically negligent. We have the ability to use telehealth to guide and treat these patients in a timely manner to avoid any long term damage.
#5 As therapy practitioners we agree to do no harm. The limitation in various insurance plans/carriers to not allow telehealth, even during this global crisis, is directly causing immediate harm to our patients and should be considered medically negligent.
Not allowing therapy via telehealth during this global crisis would negatively impact thousands of patients, hundreds of small businesses, our communities, and the nation as a whole as this virus continues to spread. Our only safe option for service delivery is via telehealth for one of our most vulnerable populations.
This is an urgent need for all insurers to include the therapy sector in the newly released CMS guideline expansion/waiver and allow telehealth as a therapeutic modality regardless of the insurance plan.
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