Expanded Health Reimbursement Arrangement Rule May Widen Use of the Employer Offering

A final rule from the US Department of Health and Human Services (HHS) will expand small employers’ ability to offer Health Reimbursement Arrangements (HRAs), a change that may make it easier for more Americans to purchase health insurance that they don’t receive from their jobs. While it’s still too early to tell if the change will significantly impact patients seen by physical therapists (PTs), APTA’s advice is to keep an eye open, and be aware of the nuances of HRA payment.

The new rule, set to go into effect January 1, 2020, will allow qualified small employers to offer what’s being called an “Individual Coverage HRA” as an alternative to traditional group coverage plans. The idea behind HRAs is that employers provide a monthly tax-free allowance to employees, who can be reimbursed for health care-related expenses up to the allowance limit. The changes set to go into effect next year would permit HRAs to be used to pay for health insurance purchased on the individual market, and allow employers to offer “excepted benefit” HRAs to supplement employer-sponsored insurance—even if the employee isn’t enrolled in the group plan.

Full story at APTA

Final HHS Report on Pain Management Adds to Drumbeat for Better Access to Nondrug Approaches

The final report from a US Department Health and Human Services (HHS) inter-agency task force on pain management best practices is out, and its call for greater collaborative care and improved access to physical therapy comes through loud and clear. It’s a report that in many ways echoes APTA’s white paper on opioids and pain management published nearly 1 year ago.

The “Report on Pain Management Best Practices” changed little from its draft version released in January [Editor’s note: this PT in Motion News article covered the draft in depth]. Like its predecessor, the report identifies gaps and inconsistencies in pain management that can contribute to opioid misuse.

While the task force acknowledges that opioids may be appropriate when carefully prescribed in some instances, it also argues that other approaches—including “restorative therapies” furnished by physical therapists and other health care professionals—should be on equal footing with pharmacological alternatives, particularly when it comes to reimbursement and patient access.

Full story at APTA

Study: Light Physical Activity Could Help to Lower Risk of Coronary and Cardiovascular Problems

No one doubts the positive health effects of regular moderate-to-vigorous physical activity (MVPA), but now researchers are finding that even light physical activity can reduce the risk of coronary heart disease and cardiovascular disease. The latest findings, focused on women age 65 and older, echo revised US Department of Health and Human Services (HHS) activity guidelines strongly supported by APTA.

The recent study, published in JAMA Network Open, asked 5,861 women with an average age of 78.5 years to wear a hip accelerometer for a week to establish PA rates, and then tracked rates of later coronary heart disease (CHD) and cardiovascular disease (CVD) for nearly 5 years. Researchers were particularly interested in the effect of light physical activity (PA)—between 1.6 and 2.9 metabolic equivalent tasks (METs)—on the risk of experiencing CVD and CHD.

Researchers divided the participants into 4 groups based on the average amount of time spent per day in light PA: 36-236 minutes, 235-285 minutes, 286-333 minutes, and 334-617 minutes. They also tracked rates of MVPA, as well as demographic, educational, and health information including the presence of chronic conditions, alcohol consumption, smoker or nonsmoker status, and use of antihypertensive and antilipidemic medications. The population studied was a mix of white (48%), black (33.5%), and Hispanic (17.6%) women.

Full story at APTA

Draft HHS Report Backs Nonpharmacological Pain Management, Calls for Better Payer Coverage of Physical Therapy

Much like an APTA white paper on opioids and pain management published in the summer of 2018, a draft report from the US Department of Health and Human Services (HHS) says that it’s time to address the gaps in the health care system that make it difficult to follow best practices in addressing pain—including improved access to and payment for physical therapy. APTA provided comments to the HHS task force that created the report.

The draft “Report on Pain Management Best Practices” now available for public comment aims to identify “gaps, inconsistencies, updates, and recommendations for acute and chronic pain management best practices” across 5 major interdisciplinary treatment modalities: medication, restorative therapies including physical therapy, interventional procedures, behavioral health approaches, and complementary and integrative health. The entire report is predicated on a set of “key concepts” that emphasize an individualized biopsychosocial model of care that employs a multidisciplinary approach and stresses the need for innovation and research.

Full story at APTA

New Physical Activity Guidelines Stress the Importance of Movement of any Duration

You want blunt? The US Department of Health and Human Services can do blunt—at least when it comes to physical activity (PA) recommendations for Americans.

“Adults should move more and sit less throughout the day,” HHS says in its latest edition of nationwide guidelines for PA. “Some physical activity is better than none.”

That’s the bottom-line recommendation that HHS rolled out this week in its revised Physical Activity Guidelines for Americans. And there’s arguably little room for nuance: according to HHS, 80% of all Americans are not meeting current PA recommendations, a failure that is contributing the prevalence of a host of chronic health conditions.

The new guidelines, with their emphasis on the importance of movement to prevent disease and extend life no matter an individual’s age, echo many perspectives long-championed by APTA and its members.

Full story at APTA

Trump Taps Price for HHS, Verma for CMS

President-elect Donald Trump has announced his hoped-for changes to leadership of the US Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), with Georgia Rep Tom Price (R-6th) to be nominated for HHS secretary, and Seema Verma, CEO of the Strategic Health Policy Solutions (SVC) consulting group, tapped to serve as CMS director.

Price joined Congress in 2004, where he now serves as chairman of the House Budget Committee, and is a member of the Health Subcommittee of the House Ways and Means Committee. Trained as an orthopedic surgeon, Price worked in private practice for nearly 20 years.

Full story of Trump choosing Tom Price for HHS at APTA

Fraud Settlements Worth More Than $35 Million Underscore Relevance of New Compliance Resource

Timing, as they say, is everything. That’s certainly the case for a recently released joint guidance document on compliance created by APTA and 3 other organizations, which arrives during a period of increased federal scrutiny of fraud associated with companies providing physical therapist services. That scrutiny resulted in settlements totaling more than $35 million.

A new resource created by APTA, the American Occupational Therapy Association, the American Speech-Language-Hearing Association, and the National Association for the Support of Long-Term Care helps health care providers understand compliance: what it is, the role of corporate compliance programs, and recommended steps for reporting. The 2-page guide also includes links to Department of Health and Human Services (HHS) Office of the Inspector General (OIG) compliance materials, and OIG national compliance hotline information.

Full story of new resource to assist health care providers understand compliance at APTA

HHS: 29% of Rehab Hospital Patients Experience Adverse Events, Temporary Harm During Stays

Close to 1 in 3 Medicare beneficiaries in independently-run rehabilitation hospitals experience adverse or temporary harm events during their stay—and nearly half of those events are preventable, according to a new report from the Department of Health and Human Services (HHS) inspector general.

The report, part of a series that also analyzed adverse events in acute care hospitals (ACHs) and skilled nursing facilities (SNFs), involved reviews of a “representative sample” of 417 Medicare beneficiaries who were discharged from independently-run (as opposed to hospital-based) rehab hospitals in March 2012. Nurse screeners identified cases that indicated adverse events, and a panel of physicians evaluated the events to rate severity, as well as to assess the possibility that the event could have been prevented. Here’s what they found:

Overall, the rehab hospitals’ rates were in line with ACHs and SNFs.
Earlier HHS studies found harm rates of 27% for ACHs and 33% for SNFs. The 29% harm rate for the rehabilitation hospitals isn’t much different.

Full story of HHS on rehab patients and temporary harm at APTA

ACA Anti-Discrimination Rule for Health Care Providers, Payers Takes Effect July 18

In a combination of changes that codify longstanding guidance and expand definitions, the Department of Health and Human Services (HHS) will very soon implement an anti-discrimination rule that could alter the ways some providers and payers manage care.

Beginning July 18, health care providers and payers that accept federal dollars will be subject to a provision of the Affordable Care Act barring discrimination in care and coverage on the basis of race, color, national origin, age, disability, and sex. As with other similar changes at the federal level, the new rules include gender identity discrimination in the definition of sex discrimination—meaning, among other things, that individuals must be allowed to enter the restrooms, hospital wards, or other gender-restricted areas that are consistent with their gender identity.

Full story of ACA anti-discrimination rule for health care providers at APTA

Extensive Overhaul of Pain Care Needed, According to HHS, NIH

More indications that the US health care system soon could be looking at pain in a new way: just days after the release of national guidelines recommending nondrug and nonopioid approaches in the treatment of chronic pain, the US Department of Health and Human Services (HHS) unveiled a “National Pain Strategy” (NPS) that calls for extensive efforts to rethink the way pain is treated, improve access to that treatment, and strengthen research and education across health care disciplines.

Development of the plan began in 2011, after an HHS-commissioned report from the National Institute of Health’s Institute of Medicine called for nationwide improvements in data collection on pain and its treatment, evaluations of the availability and effectiveness of care, public and professional education on pain, and translational and clinical research. The NPS released March 18 attempts to serve as a roadmap for accomplishing those improvements.

Full story of overhaul in pain care at APTA