Regulation is always clear and easy to comprehend. 

Laughable, right?

What often happens when new rules and regulations are proposed or finalized is that there is a flurry of activity following, from with various conceptions of intent (“Why OH why is [insert entity] doing this to us.”), implementation (“This starts, or started when?!?”),  and downright basic interpretation (“Are you reading this the same way I am reading this?”).

Thankfully, in our industry, we have a multitude of individuals who love the interpretation element. To many there is nothing more exciting than rule making season. 

Advocacy, however, when there are additional needed areas of clarification — or need I say, correction — is often more impactful when we all band together. 

Fortunately for us all, we also have numerous specialty societies and professional organizations available not only for analytics, but also for advocacy in times of need.

Most recently there was a need for the Centers for Medicare & Medicaid Services (CMS) to provide clarification of beneficiary access to physical and occupational therapy and speech-language pathology services via telehealth when furnished by institutional providers upon the expiration of the COVID-19 public health emergency (PHE) on May 11, 2023.

Many organizations including ADVION (formerly the National Association for the Support of Long Term Care), the Alliance for Physical Therapy Quality and Innovation, the American Health Care Association, the American Occupational Therapy Association, the American Physical Therapy Association, the American Speech-Language-Hearing Association, the APTA Private Practice, and the National Association of Rehabilitation Providers and Agencies banded together to seek guidance and advocate for care provision across the nation. 

So why, you ask, was clarification needed? 

Wasn’t this already covered in Section 4113 of the Consolidated Appropriations Act of 2023?

This is where interpretation, and the need to ensure clear direction comes into play.

While Section 4113 of the Consolidated Appropriations Act of 2023 (P.L. 117- 328) directed CMS to extend the beneficiary access to therapy services furnished via telehealth services initiated during the PHE through the end of 2024, the agency had not provided specific guidance to ensure that beneficiaries will continue to have access to these services when furnished by an institutional provider such as a hospital outpatient therapy department, skilled nursing facility, home health agency or outpatient rehabilitation facility. 

In the coalition’s statement to CMS, they also noted that per the Medicare Payment Advisory Commission, 63% of Medicare outpatient therapy services are furnished by institutional providers. 

Furthermore, they provided insight that this uncertainty of benefit eligibility and absence of billing guidance prior to the expiration of the PHE meant that many seniors may have necessary care interrupted, have the initiation of care delayed, or be denied access to therapy care entirely, especially in rural and underserved areas. 

The result? 


CMS has since issued an updated FAQs on waivers, flexibilities, and the end of the COVID-19 PHE to include new QA #22, which addresses policies related to remote services furnished by physical therapists (PTs), occupational therapists (OTs), and speech language pathologists (SLPs) in institutional settings after the PHE.

Q22: Following the end of the PHE, can other facilities bill for outpatient physical therapy (PT), occupational therapy (OT), speech language pathology (SLP) services, Diabetes Self-Management Training (DSMT), or Medical Nutrition Therapy (MNT) provided to beneficiaries in their homes through telecommunication technology by their staff? 


Similar to the questions we received regarding billing for outpatient therapy, DSMT, and MNT services in hospitals, in context of the end of the PHE, we have also received a number of inquiries from interested parties regarding the expiration of this policy as it relates to other facilities. We recognize that therapists and many of the other practitioners who provide these services remain on the list of distant site practitioners for Medicare telehealth services. PT, OT, SLP, DSMT, MNT providers should continue to bill for these telehealth services under the Medicare Physician Fee Schedule when furnished remotely in the same way they have been during the PHE. 

Accordingly, outpatient therapy, DSMT, and MNT services furnished remotely by institutional providers of therapy services such as rehabilitation agencies and comprehensive outpatient rehabilitation facilities, not including those that are receiving payment under any Part A payment systems (home health agencies (HHAs) and skilled nursing facilities (SNFs), should continue to be furnished and billed the same way they have been during the PHE, which can include the use of telecommunications technology and when billed on institutional claims forms. 

What about home health?

For HHAs, all services within a 30-day period of care are part of a bundled prospective payment. As was the case during the PHE, while CMS allows services to be furnished via a telecommunications system so long as the services are included in a beneficiary’s plan of care, these services cannot be considered a “visit” for purposes of patient eligibility or payment per Medicare law, nor can they substitute for a home visit as ordered on the plan of care. Medicare is requiring HHAs to report the use of telecommunications technology in providing home health services on home health payment claims on July 1, 2023, and HHAs may voluntarily report this information until that time. 

Great, what about SNFs?

For SNFs and inpatient rehabilitation facilities (IRFs), under Part A, CMS pays through a bundled payment for all covered Part A services. To the extent that therapy services furnished via telehealth or telecommunications technology are covered Part A services, then these services would be considered part of the bundled prospective payment system payment under Part A and such services would not be separately billable for those patients in a Part A-covered SNF or IRF stay. 

In conclusion, the FAQ states, again, Part B outpatient therapy, DSMT and MNT services furnished remotely by institutional providers of therapy, should continue to be furnished and billed the same way they have been during the PHE, which can include the use of telecommunications technology.

Advocacy works. 

Banding together for what is right for our patients works. 

Take some time to thank those supporting and promoting our ability to provide care daily. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab. Additionally, she serves as a member of American Speech Language Hearing Association’s (ASHA) Healthcare and Economics Committee, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected].

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.