Government Affairs Committee

October 2020

ADVOCACY: WHY DOES IT MAKE A DIFFERENCE?

The year 2020 has generated a long ‘to do’ list for therapists and their respective employers, employees, families and partners. There generally isn’t a lot of time and energy for ‘extra’ things like professional engagement.

I’d like to inspire you to spend 10-15 minutes being an advocate within the profession this year.

ADVOCACY, by definition, includes:

  • The act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support.
  • The act of advocating, or speaking or writing in support (of something)
  • The definition of advocacy is the act of speaking on the behalf of or in support of another person, place, or thing.
  • Active support for a legal cause by argument and persuasion

While the term is a noun, it represents actions that we as an individual or collectively as a group can take to educate, to connect and establish a relationship with legislators or other stakeholders revolving around an important issue. While COVID -19 impacts to practice have dominated our thoughts these past months, many other day to day issues are worthwhile to educate our legislators on, and how they affect access to physical therapy services, our patients health status and our health as essential healthcare providers.

So, what was it about the practice of physical therapy that got you excited to join this profession? What are your biggest challenges in practice today? Is it how to coordinate multidisciplinary care for a pediatric neurologically involved patient? Is it how to obtain a necessary piece of DME device for a patient with limited funds? Is it how to stay safe in a COVID-19 environment while providing optimum care for an outpatient? Whatever your key issues may be, let your voice or concerns be heard by your legislator.

Remember, Physical Therapists and Physical Therapist Assistants must be good relationship builders (patients, referral sources, payors, etc) and this extends to our legislators as well. That is why APTA has put out the call recently to make a contact with your legislators on the proposed 9% payment cut from Medicare/CMS; volume of contacts matters! Their goal was 50,000 responses and we beat that by a large margin.

I have gotten involved in advocacy for APTA Oregon and my patients, because I wanted to make sure that the stakeholders knew my patient ‘stories’ and struggles. I wanted them to understand the value of what Physical Therapy provides to society and healthcare. To educate them on some misperceptions they might have and how we make a difference every day in our patients lives. This included legislator visits to my clinic, my visits to their district and federal offices and patients sharing their concerns with them directly or remotely. These actions DID MAKE a DIFFERENCE in the communication with legislators.

Please, take a few minutes to search for YOUR Legislator, and send them an email/tweet or make a phone call on what is important to you and for your patients and our profession. If you need more information, check out www.apta.org (click on advocacy) or Search "APTA Advocacy" in your Apple or Google app stores. It's free!

Be an ADVOCATE TODAY, even if it is for a few minutes!

Karen Walz, PT, DPT, OCS, COMT, FAAOMPT
Past-President APTA Oregon


On Wednesday, September 2nd, Center for Medicare Services (CMS) announced that they decided to reverse their position on the 59 modifier and code pairing restrictions and reinstate their use starting October 1st, 2020. Firm advocacy against this policy was helpful in reversing this same ruling in April, 2020, which the APTA and other healthcare associations played a large role in. Time appears to be repeating itself as CMS did not include these rulings in paperwork sent to healthcare associations across the country, leaving no time for edits, now a second time. For example, with this new policy, CMS will not pay for manual therapy (97140) when billed on the same day as an evaluation unless it is billed with the 59 modifier. This is clearly another barrier to practice and reimbursement and as with many CMS rulings, this poor healthcare policy is likely to reach outside of just CMS. 

For the APTA's full announcement and breakdown, please click here

For an infographic on how to properly use the 59 modifier, please click here

Interested in advocating for yourself and your patients, family and friends? Sign up for the APTA's Advocacy Network as an APTA member below.

OR, attend a Government Affairs Committee meeting and get plugged in!

April 2020

As clinics struggle to stay open and clinic owners say goodbye to employees they have known for decades while other clinicians brave the front lines in skilled nursing facilities and hospitals, it is no surprise that the OPTA Government Affairs Committee (GAC) has been busy these past several weeks. Amidst the turmoil, uncertainty and shifting sands in our society from day to day, the GAC has been working hard to disseminate and make information available from our contacts in Washington D.C. and the state. They have also been hard at work in putting together Health Evidence Review Commission nominations to address state level reimbursement challenges. Additionally, the Federal Affairs Liaison (FAL) and their associated Key Contacts of OPTA GAC have been hard at work advocating for the profession and for the removal of barriers to providing care in this COVID-19 environment directly to the offices of the U.S. Congress and Senate. My hope today is to highlight this latter portion of work and the structure that makes it possible to do so.

The APTA has a collection of lobbyists, grassroots network coordinators and advocacy structures in Washington D.C. where headquarters is just a stone's throw away in Alexandria, VA. There, the grassroots and political affairs specialist coordinates representatives from each state and helps direct grassroots efforts in advocacy. That representative is the FAL. New information in a normal political climate is disseminated each month at a conference call with weekly emails. Recently, FALs have been receiving updates on a near daily basis regarding changes at the Federal level, sometimes up to three times a day.  They take all of this information, distill it and provide it to the OPTA Board of Directors (BOD), their Key Contacts (KC) and the member base with assistance from this newsletter and the website.

One of the most important roles of the FAL is to establish a bench of 2-3 KC for each senator and congressperson in the state and to train and deploy them as representatives of the APTA and OPTA in advocacy throughout the year as problems or talking points arise. The FAL also guides and assists the KCs in building long-term relationships with each representative in order to be a resource to them for all things healthcare, rehabilitation and wellness. Typically, all of this culminates at the end of each March at the APTA’s Federal Advocacy Forum (FAF) where sponsored members go to Washington D.C. to advocate in person to each member of congress and the senate from their state. This year, FAF was cancelled, and for these past three weeks, your FAL and KCs have been hard at work meeting remotely with the offices of each member of congress and senate. To date, we have met with the offices of Senators Merkley and Wyden as well as Congressman Blumenauer, Congressman Schrader, and Congresswoman Bonamici. We are fortunate to be in a state where healthcare is generally valued but the battle is not yet won and we cannot do it without your continued provision.

Your support matters. Your voice matters. Your membership dues and PT-PAC donations directly go to facilitating this structure on the federal side and directly helps get your needs heard to our politicians. You can also get involved by calling your member of congress or volunteering with the GAC. Unsure of what you should say? Reach out to your FAL, Mackenzie Van Loo, PT, DPT, CAPP-OB.


February 2020

HB 4102 passed out of the House Thursday, March 20 (55-0) and received a first reading in the Senate. The bill is part of a coalition effort by several provider associations and patient advocacy groups to improve the transparency, efficiency, and fairness of the utilization management process. When enacted it will require insurers to report the number of authorization requests processed, denied and denials overturned upon appeal, as well as mandate that utilization management policies be clearly stated and easily discoverable by both patients and providers. The bill encourages the use of electronic data exchange and places parameters around acceptable timeframes for authorization determinations and appeal reviews. It also requires that determinations be based on the best evidence available and appeal processes should be available to ensure that patients receive the care they need.

The bill is scheduled for a public hearing on Tuesday, February 25. Special thanks to the Government Affairs Committee for their efforts on this legislation, particularly to Cody Lommen and Mike Studer for taking time away from busy clinic schedules to testify on behalf of our patients and to Chris Parta for his efforts in the halls of the Capitol lobbying this bill.


June 2019
from the Oregon Patient Safety Commission

We Want Your Input

At the Oregon Patient Safety Commission, we are in the process of gathering input from key stakeholders related to Oregon’s Early Discussion and Resolution (EDR) process. EDR is a voluntary process for open conversation between care facilities, providers and their patients following serious injury or death. Physical therapists are among the providers covered by the EDR law. You can read more about EDR on our website.

How We Plan to Use the Input We Receive

Later this year, we will be sharing the input we receive with the Task Force on Resolution of Adverse Healthcare Incidents. The input will inform any recommendations that the Task Force chooses to make to the legislature about Oregon’s EDR process. All input will be anonymous and confidential.

Three Ways You Can Participate

Your perspective is important to us, and no experience with EDR is required.

  • Take our survey
  • Join a group interview: Learn more here
  • Suggest great candidates for key informant interviews by emailing Beth Kaye 

May 2019

The OPTA continues to work with our coalition partners to push SB 139 forward. We have had productive meetings with representatives from the public and private payer community, and are optimistic that the Governor will eventually sign the bill. Currently, SB 139 has been referred to the Ways and Means committee due to the fiscal impact claimed by OEBB and PEBB, but we hope that impact will be revised downward based on agreed upon amendments. The Ways and Means committee is expected to begin working through bills after receipt of the May revenue forecast for the next biennium. At that point, we hope to see progress on our efforts to improve the transparency, fairness and efficiency of the prior authorization process.

In the meantime, the Oregon Health Authority has noted the efforts and already taken steps to reduce the impact of prior authorization on access for patients enrolled in fee-for-service Oregon Health Plan options. Beginning June 1, OHA is eliminating prior authorization for therapy services. This pilot will be reviewed in November.

Changes to fee-for-service authorization of therapy services, effective June 1, 2019:

  • Providers will no longer have to request prior authorization of therapy services. Instead, they will submit documentation for the current plan of care with the initial claim. If any documentation is missing, OHA will ask providers to submit it to complete the review.
  • Based on this review, OHA will deny or approve payment of claims billed for the current plan of care.

February 2019

With the recent start of the 2019 full legislative session, the OPTA’s Government Affairs Committee (GAC) is actively supporting and monitoring bills that affect (or may potentially affect) PT in Oregon. Approximately 700 bills were pre-session filed with an anticipated 1200 to 1500 to be introduced during the session. Needless to say, it is important that our lobbyist and GAC members monitor the content of these bills to ensure the protection of our practice (and our patients’ access to care) in Oregon.

Two bills in particular have garnered our active support: House Bill 2092 and Senate Bill 139. HB 2092 was pre-session filed at the request of Governor Kate Brown for the Physical Therapist Licensing Board and renames the Board the “Oregon Board of Physical Therapy.” The OPTA actively supports this bill. As of Jan 31, 2019, this bill has had three readings and received nearly unanimous support of the House. It is scheduled for a reading on the Senate floor on Feb 5, 2019.

The other bill being actively supported is SB 139. This bill, actively supported by the OPTA, was pre-session filed and aims to address some of the concerns expressed by physical therapists and other professions regarding utilization management. The OPTA is part of a coalition of healthcare professions being adversely impact by rules and regulations involved in utilization management and helped develop the bill language; the coalition bill is scheduled for a hearing on Feb 6, 2019. Read here for Utilization Management updates. There are also several other bills dealing with prior authorization that we are tracking.

Although campaign contributions cannot be made during the legislative session, your Oregon PT-PAC donation helps our voice be heard by our elected state officials. SB 139 is anticipated to be a hard-fought legislative battle and the OPT-PAC has contributed a large amount of funds to help educate legislators regarding our perspective. Please donate to the OPT-PAC today and help our efforts to minimize delays or interruptions to patient care!

 

Government Affairs Committee meets monthly to discuss federal and state policy initiatives which impact physical therapists, physical therapist assistants, and our patients. Develops advocacy strategies to work with regulators, policy makers, and legislators on behalf of our members and their patients. Looking for committee members who are: Committed, interested in policy and payment issues, interested in learning about government processes
Contact: Chris Murphy, Chair  [email protected]