Information Pertaining to Occupational Therapy in the Era of Coronavirus (COVID-19)
As of Aug 30th, these are the latest resources for OT and telehealth in Maine
OTs should be permitted to use telehealth per this new legislation in place:
It would also appear that insurances should be covering telehealth as per in-person services as well Title 24-A, §4316: Coverage for telehealth services (maine.gov)
Maine CDC Rulemaking
This message provides notice of emergency routine technical rulemaking by the Maine Center for Disease Control and Prevention. Amendments to 10-144 CMR, chapter 264 - Immunization Requirements For Healthcare Workers have been adopted on an emergency basis. This rule is effective August 12, 2021, for up to 90 days, in accordance with 5 MRS § 8054(3).
You can access the complete rule and related rulemaking documents by going to the Maine CDC Rules webpage. Printed copies are available by contacting the person identified below for this rulemaking or Maine Relay number 711.
Additional information regarding the rulemaking process and weekly rulemaking updates can be found on the Secretary of State website .
NOTICE OF AGENCY RULE ADOPTION
AGENCY: DHHS Maine Center for Disease Control and Prevention
CHAPTER NUMBER AND TITLE: Ch. 264 - Immunization Requirements For Healthcare Workers
RULE TYPE: Emergency Routine Technical
SUMMARY: In accordance with 5 MRS § 8054, the Department is amending 10-144 CMR chapter 264, Immunization Requirements For Healthcare Workers on an emergency basis to immediately add COVID-19 to the list of vaccine-preventable diseases for which employees of a licensed nursing facility, residential care facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), multi-level healthcare facility, hospital, or home health agency subject to licensure by the State of Maine, Department of Health and Human Services Division of Licensing and Certification must be immunized. In addition, the Department is also requiring Emergency Medical Services Organizations and Dental Health Practices to require all employees to provide proof of immunization against COVID-19. Employees who do not provide proof of immunization must be excluded from the workplace for the duration of the Department’s declared public health emergency, currently in effect, which started July 1, 2021. Requiring these healthcare workers to be immunized against COVID-19 is necessary to avoid or mitigate the spread of COVID-19, including, in particular, the Delta variant, which is significantly more contagious than past versions of the virus and poses an immediate threat to public health, safety, and general welfare. Specifically, this requirement will slow the spread of COVID-19, protecting both healthcare workers and the public from infection, serious illness, hospitalization, and/or death. Additionally, this requirement will help to prevent strain on the healthcare system both by limiting the number of hospitalizations as a result of COVID-19 and by protecting individual members of the workforce. The emergency routine technical rule remains in effect for up to ninety (90) days pursuant to 5 MRS § 8054(3). To avoid any lapse in this new immunization requirement, the Department is planning to engage in the standard rulemaking process, which will, in addition to other non-emergency changes, propose these changes to become permanent.
EFFECTIVE DATE: August 12, 2021
AGENCY CONTACT PERSON: Bridget Bagley, Policy Analyst; 286 Water St., 11 SHS, Augusta, ME 04333; 287-9394; Bridget.Bagley@maine.gov
AGENCY WEBSITE: http://www.maine.gov/dhhs/mecdc/rules/
AOTA, APTA, and ASHA Joint Statement and Call for Professional Action on COVID-19 Vaccination and Education
The American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), and the American Speech-Language-Hearing Association (ASHA) have come together to call for our members and professionals to lead the way in adhering to public health practices and guidance on vaccinations and masking, to mitigate the recent surge in COVID-19 infections.
AOTA, APTA, and ASHA are the leading professional organizations representing occupational therapy, physical therapy, and audiology and speech-language pathology, respectively. Our members and professionals serve individuals across the lifespan and in all health care settings and facilities. In addition, our professionals practice in their communities as part of our school systems and are frontline providers in homes and workplaces.
On July 30, 2021, AOTA was added to the list of signatories on this Joint Statement in Support of COVID-19 Vaccine Mandates for All Workers in Health and Long-Term Care.
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.
Update on CMS Authorization for OTs to Open Medicare Home Health Cases
As part of the emergency waivers, the Centers for Medicare & Medicaid Services (CMS) has temporarily authorized occupational therapists to perform initial and comprehensive assessments for all home health patients receiving therapy as part of the plan of care. AOTA has obtained clarifications about the waiver from CMS staff and created a new FAQ resource for practitioners. View Part 1 and Part 2 of AOTA's COVID-19 webinar series about what OTs need to know about starting Medicare home health cases. See all AOTA's information on occupational therapy in the era of COVID-19.
When the COVID-19 crisis ends, we anticipate our ability to practice telehealth will be eliminated with cancellation of the executive orders from Governor Mills. MeOTA is looking to garner evidence and support now so that we can advocate for further OT telehealth coverage in the future. We would like to gather key data points about therapists’ and clients’ experiences with telehealth and reimbursement. MeOTA Telehealth Data Tracker.doc
AOTA and MeOTA wanted to give you a heads up on a state-level campaign that has been initiated by the National Association for the Support of Long Term Care.
They are asking their members to “contact your state governor’s office and urge them to temporarily suspend or waive the state supervision requirements for physical therapists, occupational therapists, and speech-language pathologists for the duration of the COVID-19 emergency.”
We are concerned that this request is premature and could have unintended consequences. Please stay tuned for more information before taking any action.
Governor Mill's four-stage plan for opening the economy. Here is the link: https://www.maine.gov/governor/mills/news/governor-mills-presents-safe-gradual-plan-restart-maines-economy-2020-04-28
The Governor’s Plan allows certain health care services to reopen in Stage One. This includes: “Health care from Maine licensed providers, with a recommendation that they prioritize care for patients with time-sensitive conditions; assure the safety of patients, staff, and communities; manage the use of essential resources such as personal protective equipment and testing supplies; and pace reopening services to the level of community COVID-19 activity, maintaining capacity in our hospitals for potential outbreaks.” Reopening is optional and subject to the provider’s adoption of safety recommendations in the Maine DHHS COVID 19- Guidance for Health Care Providers (“DHHS Guidance”) https://www.maine.gov/dhhs/documents/coronavirus/COVID-19-Guidance-for-Health-Care-Providers-043020.pdf.
The DHHS Guidance includes occupational therapy. Occupational therapy services that are offered pursuant to the DHHS Guidance needs to comply to all of the requirements of the DHHS Guidance and the referenced US CDC Infection Control Guidance for Health Care Professionals about COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html.
AOTA Medicare Telehealth Success!
The Centers for Medicare & Medicaid Services (CMS) announced the long awaited news today, April 30th, that occupational therapists, physical therapists, and speech language pathologists can now perform telehealth services for Medicare beneficiaries.
Based on the language in the new blanket waiver, AOTA is immediately seeking clarification regarding whether it extends to occupational therapy assistants, and will be advocating for inclusion. The waiver is retroactive to March 1, 2020 and is effective throughout the public health emergency. Telehealth services can be billed using the list of telehealth approved CPT® codes that CMS issued on March 30, 2020. AOTA will be developing a more in-depth article with billing guidance, listing the available CPT codes.
AOTA has been proactively and tirelessly advocating for this change with the U.S. Department of Health and Human Services (HHS) and CMS through many means, including meetings, the submission of comment letters, and development of a fillable template comment letter for the profession to engage in advocacy directly. On April 6, AOTA, along with APTA and ASHA, met with CMS to discuss the CARES Act waiver authority to expand the list of telehealth eligible professionals and implore CMS to allow OTs, PTs, and SLPs to perform telehealth immediately amid the COVID-19 PHE.
AOTA is analyzing additional Medicare flexibilities in the 1135 waiver. Additional changes include increased payments to telephone services retroactive to March 1. CMS is also allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. AOTA continues to analyze the new waiver and will provide an update on any additional flexibilities. Read the full press release.
These waivers from the Centers for Medicare and Medicaid Services were updated on April 9th.
CMS Allows OTs to Open Medicare Home Health Cases
Allow[s] occupational therapists (OTs) to perform initial and comprehensive assessment for all patients. 42 C.F.R. 484.55(a)(2) and 484.55(b)(3). CMS is waiving the requirement that OTs may only perform the initial and comprehensive assessment if occupational therapy is the service that establishes eligibility for the patient to be receiving home health care. This temporary blanket modification allows OTs to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether occupational therapy is the service that establishes eligibility.
The continued spread of Coronavirus Disease (COVID-19) across the globe has sparked concern in the occupational therapy profession regarding practice, options for delivering quality therapy services while doing our part to slow the spread and “flatten the curve,” and academic requirements for educators and students. AOTA is continuing to closely monitor this fluid situation, and has compiled resources to answer practitioners’ frequently asked questions.
AOTA’s top priority as we navigate this pandemic together is the health and safety of occupational therapy practitioners, students, and the clients they serve. We will update this page as information becomes available and will continue to empower students, educators, and clinicians to navigate these unprecedented circumstances.
Resources for Occupational Therapy Practitioners
· OT and Telehealth in the Age of COVID-19: Additional flexibilities for telehealth have been incorporated into both federal programs and private insurance. However, these flexibilities don’t always expand the definition of who can provide telehealth services.
· Looking for information on whether you can use telehealth in your state and considerations for practice while many areas are under precautions for COVID-19? AOTA’s Telehealth Resources page contains resources to help OT practitioners to navigate this emerging area.
· AOTA has created a comprehensive list of State-by-State Resources pertaining to COVID-19 (PDF)
· CMS Guidance to Providers About COVID-19: The Centers for Medicare & Medicaid Services (CMS) has taken action to protect the health and safety of our nation’s patients and providers in the wake of the COVID-19 outbreak. This includes clear, actionable information on the screening, treatment, and transfer procedures to follow when interacting with patients. AOTA recommends you review CMS actions if you treat Medicare or Medicaid beneficiaries, many of whom are at high risk for COVID-19.
· Provision of Special Education, Early Intervention, and 504 Services During the COVID-19 Outbreak: On March 12, the U.S. Department of Education released guidance on how to continue providing services to children with disabilities during the COVID-19 outbreak. Based on that guidance, AOTA has provided some answers to the most frequently asked questions.
· To connect with your colleagues and learn more information as this situation develops, visit AOTA’s online community, CommunOT.
AOTA is continuing to develop more resources pertaining to COVID-19. Please check back for more information, which will be posted here as it becomes available.
Stateside Associates is publishing a state by state chart of state legislative actions, executive agency actions, and gubernatorial actions related to the outbreak of the coronavirus.
MaineCare Guidance Relating to Telehealth and COVID-19
As we respond to COVID-19, we encourage MaineCare providers to consider utilizing telehealth services for the delivery of MaineCare-covered services when appropriate and necessary. MaineCare has long had a robust telehealth policy and has recently created additional flexibility for its usage. Please read this message in its entirety to understand your options and additional resources.
Utilizing Telehealth to Satisfy Face-to-Face Requirements in MaineCare Policies
Telehealth allows providers to deliver services to individuals remotely so that providers can monitor and address health conditions. This can be done through Interactive Telehealth Services, which are real time, interactive visual and audio telecommunications; or telephonically when Interactive Telehealth Services are unavailable.
With few exceptions such as personal care services and ambulance, telehealth can be used to satisfy the MaineCare face-to-face requirements when telehealth delivery of the service is of comparable quality to in-person service delivery. Providers are also required to ensure they are complying with all federal, state, and local regulations that apply, including HIPAA requirements, when network services are used.
Member & Service Criteria for Telehealth Eligibility
The significant majority of medically necessary MaineCare-covered service may be delivered via Interactive Telehealth Services if the following requirements are met:
If a member is eligible to receive the underlying covered service, and if delivery of the covered service via telehealth is medically appropriate as determined by the health care provider, the member is eligible to receive telehealth services. For services that traditionally have not been considered medically appropriate or of comparable quality via telehealth (e.g. Intensive Outpatient Treatment (IOP) or Home & Community Based Treatment (HCT)), providers are encouraged to consider alternative treatment options that could be more appropriately delivered via telehealth (e.g. 1:1 counseling visits).
Delivery of Telehealth via Telephone
In addition to Interactive Telehealth Services, telephones are an acceptable mode to deliver telehealth if Interactive Telehealth Services are unavailable, and if Telephonic Service is medically appropriate for the underlying covered service.
Prior Authorization (PA) Requirements
Prior Authorization (PA) is only required for Interactive Telehealth Services if a PA is required for the underlying covered service. In these cases, the PA relates to the underlying covered service, not to the telehealth mode of delivery.
Telehealth and Pharmacy – NEW!
Through emergency rules, going forward the Department will allow for prescribing through telehealth.
Two distinct sites are necessary for delivering interactive telehealth. The first site – called the Originating Site – is where the MaineCare member is located when receiving the service. The second site – the Receiving Site – is where the provider who is administering the covered service or consultation is located.
The Originating Site can be a member’s home, nursing facility, long-term care facility, or other health care facility, with telehealth capabilities.
Telehealth Provider Eligibility
To receive reimbursement for telehealth services, a health care provider must be:
· Acting within the scope of his or her license,
· Enrolled as a MaineCare provider, and;
· Otherwise eligible to deliver the underlying covered service according to the requirements of the applicable section of the MaineCare Benefits Manual.
Billing for Telehealth
In general, services must be billed in accordance with applicable sections of the MaineCare Benefits Manual. Providers must submit claims in accordance with Department billing instructions. The same procedure codes and rates apply to the underlying covered service as if those services were delivered face-to-face. When billing for Interactive Telehealth Services, health care providers at the Receiving (provider) Site should bill for the underlying covered service using the same process they would if it were delivered face-to-face; with the addition of a GT modifier to the claim.
Reimbursement for Originating Sites
In general, when a member is receiving telehealth services, any health care provider who is present with the member at the Originating Site (where the member is, e.g. a nursing facility or the member’s home), may not bill for assisting the health care provider delivering the covered telehealth service from the remote Receiving Site. However, if a health care provider at an Originating site is not providing clinical services but is making a room and telecommunications equipment available, that health care provider may bill MaineCare for an originating facility fee using code Q3014 for the service of coordinating the telehealth service.
Telehealth Resources for Providers
Providers who need assistance with implementing and/or have general billing questions regarding telehealth services are encouraged to contact the Northeast Telehealth Resource Center (NETRC) by email: firstname.lastname@example.org or 1-800-379-2021. Specific questions can also be submitted to NETRC at https://www.netrc.org/contact.php. Many other helpful telehealth resources are available on NETRC’s website including NETRC’s Telehealth Toolkit for COVID-19.
MaineCare providers with telehealth questions related to MaineCare-specific billing and/or policies should contact their provider relations specialist or call Provider Services at 1-866-690-5585.
MaineCare encourages providers who would like to learn more about telehealth to participate in the National Consortium of Telehealth Resource Center’s webinar on March 17th related to telehealth and COVID-19.
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