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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June 20, 2019

BCBSM/BCN provided MPTA advanced noticed of a change in Provider Categorization to begin January 2020. BCN, BCNA, and BCBSM MA categorization programs will be streamlined into a single categorization grade for a given IPT or OPT/HOPT.  Categorization will continue to be tied to prior authorization. However, prior authorization will NOT be used for the BCBSM PPO. More details to be announced in the near future by BCBSM/BCN. MPTA continues to advocate for outcome-/value-based payment models and outlier-based approaches to utilization management, and will be meeting with BCBSM in July.

 

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June 20, 2019

House Bill 4108, which adds Physical Therapists and Physical Therapist Assistants to the list of mandatory reporters of suspected child abuse has passed in the House with a vote of 107-2 on June 19, 2019!! A huge thank you to all members who reached out to their legislator in support this initiative, and to Rep. Roger Hauck from Mount Pleasant for introducing this important piece of legislation. Please take a few moments and thank your legislator for voting YES!

 

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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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