November 13, 2019

We are very excited to announce the introduction of Senate Bill (SB) 612 which seeks to reform prior authorization practices in Michigan.  This bill is the result of our collaboration with a large provider and consumer advocacy group coalition called Health Can’t Wait.  The legislation is but 1 component of the this campaign that also includes consumer education and collection of patient stories.

The bill is sponsored by Senator Curt Vanderwall (Benzie, Crawford, Kalkaska, Lake, Leelanau, Manistee, Mason, Missaukee, Ogemaw, Osceola, Roscommon and Wexford).  The most important parts of the bill that impact physical therapy include:

  • Requiring payers to post prior authorization requirements on their public website and be readily available to providers at the point of care
  • Criteria that are based on peer-reviewed clinical review criteria which:
    • Must be based on national association guidelines
    • Account for atypical patient populations/diagnoses
    • Ensure quality of care
    • Be flexible for case-by-case deviation
    • Evaluated and updated annually
    • Be developed with input from health professionals licensed in the same profession
  • Requiring payers to “conspicuously” post statistics about denials and appeals, including the top 10 reasons for denial, on their public website

Please contact your State Senator and State Representative NOW and tell them about the adverse impact that prior authorization is having on our ability to deliver medically, necessary care to our patients.  For more information on the Health Can’t Wait coalition and to submit your patients’ stories, visit https://www.healthcantwait.org/

 

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November 05, 2019
BCBSM and eviCore prior authorization: Survey opportunity to provide feedback
BCBSM posted a notice in The Record that they are seeking feedback on their utilization management services. To take the survey CLICK HERE. The survey will stay open until December 31.
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November 05, 2019

Meridian Medicaid now requires pre-treatment authorization, and has implemented eviCore’s Core-Path process similar to BCN and MPB.

Meridian states the authorization may take up to 14 days, but early indicators have shown a much shorter time frame.  This was implemented November 1, 2019. 

https://www.evicore.com/resources/healthplan/meridian-wellcare

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September 23, 2019

MPTA Members participatedin the APTA State Policy and Payment Forum (SPPF) on September 14.  

 

John Zubek provided these notes about the experience~

A first timer’s perspective attending the State Policy and Payment Forum

OVERWHELMING support! For our patients, for our profession. That’s the message I hear while sitting in a room of a few hundred Physical Therapy representatives from every state in the U.S. As I looked around, I saw clinic owners, administrators, lobbyists, chapter presidents, payment specialists and staff physical therapists. Here are few of my takeaways from the Forum:  

  • The APTA is expending an enormous amount of expertise, effort and time influencing legislation and reimbursement rules for the benefit of our patients.  
  • It is important that we meet with other state chapter representatives and learn from their successes and failures.  
  • Our dues and donations really do help MPTA representatives extend and expand our voices. 
  • I experienced genuine optimism for the future of our profession and the value we provide to the patients we serve.  
  • The State Policy and Payment Forum was truly an eye-opening experience and an important wake up call to stay involved.  

 

Those that attended are pictures below left to right:  John Zubek (Leg Ctte), Barb Herzog (Payment Specialist), Jena Colon (Leg Director) and Karen Frederick (Shorelines Editor and member of the APTA Public Policy and Advocacy Committee - PPAC).  

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September 12, 2019

Planning for the Future of Clinical Education

APTA, the Academy of Physical Therapy Education, and the American Council of Academic Physical Therapy are collaborating through the Educational Leadership Partnership to reshape physical therapy clinical education.

 

Three years ago, as a physical therapist assistant (PTA) student at Brigham Young University-Idaho, Brendon Larsen, PTA, like his classmates, was required to complete 2 clinical internships. The rotations, he recalls, were "really varied": One primarily was inpatient, the other mostly outpatient, and they exposed him to everything from home-based wound care and pediatrics to palliative care and sports medicine. "I wouldn't say I loved every aspect of my clinicals. I saw a lot of patients whose conditions were outside the niche I'd envisioned for myself. But their variety taught me a lot about the profession and led me to where I am today," Larsen says.

Click here to read the rest of the article

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August 19, 2019

In recognition of the ongoing challenges faced by our members related to payment, the MPTA Board established a part-time Payment Specialist position.  We are happy to announce that Barbara Herzog, PT will be working in this position.  Her full bio is below.  To contact Barb with your questions and concerns, email [email protected].  After verifying your membership status, Barbara will respond.  

Barbara Herzog, PT - MPTA Payment Specialist

Barbara Herzog has been a physical therapist in Michigan for 38 years after graduating from the College of St. Scholastica, Duluth, MN.  She spent the majority of her career in private practice owning a contract/personnel placement company, Private Practice/Rehab Agency, and medical wellness/fitness center and eventually selling those businesses in 2011.  During that time, she was active in advancing private practice, fair reimbursement and the recognition of physical therapy services as a profession not only in private practice but in settings such as home care, worker’s comp and auto. 

Barbara’s professional membership includes multiple years with PTPN as president, and she has been a member of APTA/MPTA since 1988.  She has been continually active with APTA/MPTA serving as Vice President 2009-2010, federal affairs liaison, legislative committee member and payment and policy committee member.  She has worked closely with multiple commercial insurance companies, self-insured employers, TPA’s, and other entities to facilitate and negotiate equitable payment and policies for the physical therapy profession in all settings.  She attends payer meetings – Worker’s comp, HMO’s, commercial insurance PPO’s, and state funded plans. 

Barbara remains a passionate practicing PT, currently working in several practice settings:  hospital out-patient, private practice clinic and home health.

 

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August 01, 2019

The MPTA Payment Committee met with BCBSM on July 30, 2019.  We were able to openly discuss key issues in regards to eviCore prior authorization as it relates to criteria for neurological conditions, orthopedic conditions, and complex cases. The eviCore neurological pathway was implemented June 1, 2019 with few errors according to eviCore representatives. We welcome your input as to any difficulties you have had with prior authorization for neurologic conditions. MPTA continues to pursue alternatives to the current UM program by advocating for value-based payment structures and/or a change from prior authorization to outlier management models.

Payment for services under Direct Access is discussed at each meeting with BCBSM. We were asked to better define the parameters of our state practice act and law, national trends and where Federal law does have impact, and CMS recognition of Direct Access. MPTA will be providing BCBSM with available data. 

Regarding provider categorization, it was confirmed that they are shifting to a single BCBSM tiering model for categorization. This includes categorization based on percentage of peer mean utilization adjusted for age, gender, and diagnosis. Although MPTA remains concerned about categorization based primarily on utilization with minimal risk adjustment, the MPTA believes this change is beneficial as it streamlines categorization into a single process across all BCBSM/BCN products. This is effective 01/01/2020 for PPO, MA/PPO, and BCN/BCNA.  Category notification is delayed until new tiering is implemented, which will then be issued bi-annually January and July.  Updates are available on WebDenis and letters to providers will be mailed in February 2020.  Expect to remain in your current categorization until January. 

Please note MPTA correspondence with BCBSM found on the Payment Resources page

 

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April 24, 2017

The Physical Therapy Section of the Public Health Code has been amended to allow Advanced Practice Registered Nurses to prescribe physical therapy:

 

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****



333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

 

 

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

Section 17201:

Sec. 17201. (1) As used in this part:

(a) “Advanced practice registered nurse” or “a.p.r.n.” means a registered professional nurse who has been granted

a specialty certification under section 17210 in 1 of the following health profession specialty fields:

(i) Nurse midwifery.

(ii) Nurse practitioner.

(iii) Clinical nurse specialist.

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****

 


333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

 

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

 

 

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