CMS Cracks Window for Virtual Therapy Visits in Nursing Homes Amid COVID-19, But Barriers Remain

Therapy providers were partially included in the federal government’s attempts to waive restrictions on various health providers amid the coronavirus, but some experts say this recent round won’t enable sufficient virtual care for nursing home residents — and also doesn’t decrease the risks therapists are experiencing on the ground amid the pandemic.

An expanded telehealth initiative, announced by the Centers for Medicare & Medicaid Services last Tuesday, removed several regulatory barriers to doctors providing remote care in the nursing home sector, which now includes telehealth coverage in non-rural communities.

The move also allows providers to perform interventions over consumer platforms such as Skype and FaceTime without fear of receiving HIPAA citations, a sweeping move that opens the door for more telehealth.


So far, therapists were left out of the telehealth mix, although e-visits — authorized by a blanket 1135 waiver — are a first step by the federal government to virtually involve therapists during the outbreak.

For therapists, e-visits are a form of electronic communication initiated by a returning patient through a virtual portal, and do not include face-to-face interactions. There are some discussions about patients initiating phone calls to their physical, occupational, or speech therapists for the e-visits, although some therapy groups are still confirming this option.

“You’re not treating a patient through the visit. You’re not able to do an evaluation of the patient,” Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care (NASL), told SNN. “It’s merely the patient initiating a call [or check in via portal] to their clinician saying something like, hey, I’ve been working on my home exercises, and I’m getting a little short of breath when I do them. Is that normal? It’s almost like an inquiry.”


And although doctors, nurses, social workers, and other health care workers are empowered to use telehealth, “it does not include rehab therapists who, you know, next to nursing are providing the majority of the care in those in those buildings,” Morton said.

Some private payers are opening telehealth options for therapists, such as Louisiana Blue Cross Blue Shield, according to Morton, and NASL would like to see this service clearly offered to all patients, instead of focusing on Medicare Part B long-stay residents, Morton said.

“We’d like to see PTs, OTs and SLPs be able to provide actual services, so that we can help and decrease who is being exposed to the virus,” she said.

In agreement with NASL, the American Occupational Therapy Association (AOTA) is pleased to see some movement for remote access to patient care for therapists, but its leaders claim e-visits don’t go far enough.

“We would love to see therapists being allowed to perform telehealth. And in that regard, AOTA continues to advocate with Congress to increase access to therapy services under occupational therapy services under Medicare,” AOTA’s vice president of regulatory affairs Sharmila Sandhu said. “So we’ve got a write in and legislative action center effort that’s been ongoing, but it’s heightened as a result of COVID-19.”

As it stands, therapists who participate in e-health communications would need a specific digital platform in order to trigger particular services. It is unclear how many nursing homes have this technology — and if they don’t have it, the question remains if facilities would be able to acquire and implement the technology in a timely manner.

AOTA is currently exploring the availability of such patient portals in a survey this week.

“I think depending on the setting where you work, you may or may not have access to one. This is similar to what many primary care physicians have with their patients, where they can e-mail them blood test results, for example, etc. and the patient can ask questions using that portal,” Sandhu said.

CMS states that Medicare B patients will be eligible for e-visits, or that providers can bill independently for Medicare with various online assessments. The assessments may accumulate up to seven days and range from five to 21-plus minutes, but the specifics involving the parameters of these visits are still being worked out.

“I know CMS is doing the best they can so far, and maybe we’re going to get more as the days go by. But the important thing is that we first consider the patients in those nursing facilities — and they do need therapy,” Morton said. “But we can do it by limiting who can get in the building with a tool that’s already available and already being used around the country. We just need Medicare patients to be able to benefit from it.”

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