Therapy leaders are advising physical and occupational therapists, as well as speech language pathologists, to minimize their use of telehealth in nursing homes and other institutional settings until federal regulators provide more clarity on payment procedures in the post-pandemic era.

The US public health emergency was declared over Thursday, but a coalition of therapy providers had questions unanswered as to whether they could continue operating under pandemic-era special allowances until the end of 2024.

Staff at the Department of Health and Human Services told leaders at the American Physical Therapy Association that the issue is in the midst of a legal review that is unexpectedly tangled. Long-term care group Advion is a member in the therapy coalition pushing for clarity.

“Providers in certain settings should take a careful approach,” the therapy association told its members Thursday night after it was clear that regulators would not be responding before the PHE expired that day.

According to the group, PTs, OTs and SLPs in private practice settings and some facility-based settings are allowed to continue to provide services under Medicare via telehealth — likely until Dec. 31, 2024, in fact. But therapists who use the UB04 claim form in certain facilities appear not to be eligible any longer.

Affected settings include skilled nursing facilities, home health agencies and rehabilitation agencies. Therapy organizations say they caught the inconsistency early on and “have been urging CMS to fix the exclusion — or at the very least, explain the rationale behind it — ever since.”

Advion Executive Vice President Cynthia Morton renewed her call for a prompt resolution Friday.

“Without clear and timely guidance from CMS, this puts providers in a risky situation,” she told McKnight’s. “Many providers, especially in rural areas, are depending on telehealth in order to get services to patients. Without the CMS guidance, providers have no clarity in order to bill for these services and therefore can’t bill. We need CMS to conduct the legal review that they want to do rapidly so that we can clear this up quickly.” 

At a meeting Thursday with staff from HHS Secretary Xavier Becerra, APTA staff members were warned that answers would not come quickly. The staffers also declined to estimate when guidance would be issued, APTA noted.

“Basically, we were told that this issue is a priority, but that due to legal complexities, it’s taking longer than anyone would like to perform a legal analysis,” said Kate Gilliard, JD, APTA’s director of health policy and payment. “There are three years’ worth of waivers, legislation, and regulations that have to be untangled and, unfortunately, it’s extremely complicated.”

The APTA has advised its members using the UB04 form to proceed carefully. It recommends emphasizing in-person physical therapy and avoiding providing telehealth services when possible.

It also suggests providers secure an advance beneficiary notice from the patient if telehealth cannot be avoided.

“Make it clear that your services may not be covered by Medicare,” APTA advised, adding that it can’t guarantee that an ABN would lock in a provider’s ability to bill the patient in the event that Medicare doesn’t pay for the services “… but using an ABN may increase that likelihood.”

Also be in close contact with your Medicare Administrative Contractor to confirm that telehealth claims will be payable, just in case CMS later decides otherwise, the group advised.