Medicare guidelines concerning Board challenged PTA`s

I was told by my employer that as of april 1,2007 board challenged PTA`s under medicare guidelines cannot bill for inpatient hospital therapeutic services which means I am out of a job. Has this happen to anyone else out there? Is your livelihood at risk? What other options are there.

I am affected as well here in Northern California. I have been a therapist for 11 years; this new change will impact those potentially in the field 30 years. CMS recently published new information (R65BP) impacting PT Assistant positions working in inpatient, outpatient, skilled nursing, and acute rehab programs. In summary, medicate as of April 1st, 2007 will not recognize treatment by PT Assistants from 1977 forward who did not complete an accredited college PTA program. Across the nation this will impact thousands of therapists where as a nation there is no "uniformity". That is to say, these guidelines will impact therapists that are Military trained, those that are only certified, those that work in states that have no licensure or regulation or registration. It was widely known Medicare was heading in this direction for outpatient services, but many now are scrambling after this unexpectedness. The organization I work for appears to be the only one with immediate action. Others don't seem to have the information or awareness yet. Speaking with attorneys in this matter for interpretation has been mixed. The wording is very convoluted, but unfortunately they have determined it to mean what I have feared. It also appears Medicare has put this new wording in hap-hazard without the knowledge of how unregulated PTA's are across the nation, making this very suspicious...do they know the impact? I know the APTA does not recognize therapists who did not meet the same requirements Medicare now imposes, but I'd hate to think they had any input towards this? What can we do, well it's at the federal level, state boards will be of no help. If the numbers of those affected join, then lobbying is a route to consider. Until then we are unfortunately boycotted, and discriminated from; no employer wants to modify treatments a therapist can see because of insurance coverage, that could be interpreted as a violation by our ethics laws.

Today marks my 14th year as a PTA at the Hospital. I just learned about 2 hours ago, that I will not be able to work with Medicare patients because some government lacky decided that I'm not qualified!
I challenged the board 30 years ago! I have 2 Master's degrees! Obviously, I have not learned how to do my job during this time according to our government.
I suggest we all begin to contact our Congress people and ask why we cannot be grandfathered in as normally done when qualifications are changed/altered.
Even more suprising, it usually takes months, if not years for government to implement such sweeping legislation; not weeks! I'm almost wondering if this isn't some April 1st joke? Does this have to do with saving money for Rx coverage? This simply makes no sense.
I get to help pay the salary of people (Medicare) that haven't a clue and are now denying me employment. What a great system.
The other irritating

When I signed up for this forum I had not yet decided to go into OT instead of PT. I'm starting school this Fall so this situation should not affect me, but I wanted to comment that I suspect there will be some kind of greased-skids certification procedures for those affected.
I've taught GED and it's like reading one magazine compared to 4 years of high school.

Chobers, A "greased-skid" certification is only wishful thinking. By definition Medicare has defined the education as approved by the APTA. The APTA is not going to make short cuts for anyone. The definition also states "licensed" where across the nation only 45 jurisdictions regulate PTA's. 36 require licensure, 6 only certification, 3 states require registration, 2 states define PTA but have no regulatory language, and 6 with no language defining them at all. I think the APTA would like to see a nationwide uniformity...Medicare has imposed this already by their definition. As a PTA with a license by equivalence, this really sucks. It means going back to school for a license I already have; taking time away from my kids and the financial impact grave.

I am Certified Athletic Trainer who went throughtthe proper channels to challenge the boards for the California PTA. I also have Master's in Exercise Science and have taught at the University Level. The NATA has an ongoing battle with CMS to allow ATC's to treat Medicare patients (the physically active) Does this mean that if the NATA wins out, I could treat Medicare patients as an ATC but not a PTA? Ironic thatthe license I reluctantly pursued and received may not be valid, butthe certification I have had for 19 years would be.

CMS had basically said that the PTB of California had granted illegal licenses. Where does this end? Will PT's with BS degrees be next?

Whatever, happened to grandfather clauses?

How about the millions in unemploymnet that may arise from this action?

Licensing is to help keep the public safe. I have been fingerprinted, met the requirements, and I do my job. This hurts the public because hundred's of medicare recipients won't be getting treatments after April 1st, because there arem't enough PT's or PTA's to do the job.

NM said: I was told by my employer that as of april 1,2007 board challenged PTA`s under medicare guidelines cannot bill for inpatient hospital therapeutic services which means I am out of a job. Has this happen to anyone else out there? Is your livelihood at risk? What other options are there.

We were told the same thing. It is in my opinion a misinterpretation of the guidlines. they only read the first part but not hte last part. I believe PTAs in this position need to obtain a labor attorney and have the attorney contact medicare on their behalf. " Physical Therapy Assistant. A person who is licensed as a physical therapy assistant, if applicable, by the State in which practicing, and (i) Has graduated from a 2-year college-level program approved by the American Physical Therapy Association; or (ii) Has 2 years of appropriate experience as a physical therapy assistant, and has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service, except that these determinations of proficiency do not apply with respect to persons initially licensed by a State or seeking initial qualification as a physical therapy assistant after December 31, 1977." You will notice that it states that this level of proficieincy does not apply to persons initially licensed by a state after 1977. Many are just reading the first part of the statement. This is only my opinion and currently does not affect me but I feel bad for PTAs that have devoted thhemselves to the careof the elderly.

Sincerely
Douglas Phillips PT

I'm one of the affected. I would like to suggest to anyone that reads this site to contact the author of this new policy at CMS:

Dorothy Shannon,Phd,SLP
410-786-3693 (direct line)
or, dorothy.shannon@cms.hhs.gov

There will be a meeting in Washington regarding this matter next Tuesday, March 27 with: CMS,APTA, National Hospital Assoc.
I also strongly writing your state reps, etc. if you really care.
Thank you.

We need to contact our Senators right away. We need people intervening on our behalf. What about a federal class action law suit? We cannot just sit back and do nothing, while our livelihood are taken away. I have a Bachelors Degree and have been licensed for 17 years treating patients, but next week I won't be qualified to treat Medicare A? I love being a therapist and I don't want that taken away by some government employee that has some agenda!

Everyone that is affected needs to get involved now. Time is running out!

Tom Hall, PTA said: I'm one of the affected. I would like to suggest to anyone that reads this site to contact the author of this new policy at CMS:
Dorothy Shannon,Phd,SLP
410-786-3693 (direct line)
or, dorothy.shannon@cms.hhs.gov
There will be a meeting in Washington regarding this matter next Tuesday, March 27 with: CMS,APTA, National Hospital Assoc.
I also strongly writing your state reps, etc. if you really care.
Thank you.

Thank you Tom for your your information and I will definately call the person you mentioned. I care alot and feel that united we can overturn this. Please let me know what other things I can do.

Thank you AB for your coments and since I started this E-MAIL I have gotten good response and suggest you look at the current e-mails and comments sent. I strongly beleive that united that we can overturn this. Unfortunately, the APTA does not recognize us as members of a physical therapy family or they would at least have our state board contact board challenged PTA and give us options on how to go forward vs just throwing us under a bus. They did not issue us limitted licences when we applied and we should not let it be so at this point. So continue to be active and fight the good fight. We are right, we are just, and we can not be denied of the profession we love and enjoyed for years and have some red tape erase the good we do.

Thank you TH for the comments and please check out the latest E-mails on this subject. United we can overturn or at least bring a stay on this until both sides can be heard. I believe that the APTA and our state board should treat us as family members vs putting us under a bus. We did everything that was asked of us and we were not issued limitted licences. So please be active and fight for the rights of a level playing field vs the unjust terms that medicare, APTA, or the State Boards and local Hospitals is placing on us. Our livelihood is at stake. Thank you.

Thanks Chobbers for the reply. I just want you to know that We are just in our cause and united that we can bring about a change. It is incredible how a profession that I love and put years of hard work and sacrifice to become a member of a Physical Therapy profession, that the APTA nor my State Board will not come to my rescue nor other PTA`s in the same situation. Atleast give us an opportunity to be heard. I have spoken to alot of RPT`s and OT`s and they all say that this does not make any since and more should be done to claify and give an opportunity to make this right vs thowing Challenged PTA`s under a bus. Please help us by being active in this and I`m sure you want to go into a profession that is strong vs separating it`s members.

Thank you LDH for your response and please see the other e-mails that are on line. We did everything that was asked of us yet does the APTA or our State Board help as family members in our cause or do they ignore us as family members and side with medicare and causes thousands to lose their livelihood. We were not issued limitted licences and united we can let the powers that be know that we have a voice and deserve to be heard.Please stay active and fight the good fight. Single parents with kids,people who been in their profession for 1,5,10,20 and 30 years, hard working decent PTA`s that done this profession proud,should be acknowledge as health care professionals that we are and valuable members of a health care organization instead of being thrown under a bus to be forgotten about.

Thank you Mr Phillips for your response. Please see the other e-mails that were sent on this topic. We are just and feel that Medicare, APTA, State Boards and Hospitals should not place their employees nor family members at risk of losing their livelihood over an unclear and confusing document that is not at the best interest of patients nor the facilities that it governs.I personally take pride in the job that I perform and my employer`s would all confirm this as well as the majority of other Board challenged PTA`s would. I have spoken to alot of RPT`s and OT`s and they feel that this just does not feel right and I have asked everyone to please have a say in this and let a communication and dialogue between all entities come together to make sense of this all. I personally ask you to support us so that we as a profession can become united and grow strong in the years to come. Thank you.

I strongly suggest that we contact a local representative whether it is a congress person, attortney, Senator, TV station ect.. Remember this is a local,regional and national issue and this is what I beleive a strong platform for all of us, and even more people affected to join in this battle. Not only is our livelihood involved but our families,our health as well as our family stability,plus more pressure on the RPT`s and PTA`s to have a heavier work load which will greatly affect the quality of care, of the patient`s we love to take care of and give optimum outcomes to. This also will affect MD`s, Nursing, and the flow of a medical team that relies on competence and frequency of care. How about finding a meeting place here in southern California and giving a phone number for persons out of area or state to communicate? There is strength in numbers and we must organize to suceed. We all have to be active and not stay on the sideline while a few put in the work. Please reply Thank you.

As of this morning, my understanding from my director, is that that CMS/100-02 has been rescinded. But by no means to I feel any better, or that my job is safe. The meeting on 3-27 is certaintly of interest.

My understanding is that Tranmittal 65 was rescinded, not 100-02. I am awaiting official notice and will post a message when available. If you are in Orange County California, contact Cerritos College and inquire about the fast track program for licensed PTAs who challenged the board. They are offering a 1 year program for all of you who are affected. I imagine this will fill up quickly. Ask to speak to the program director. Good luck.

I'd like to quote a letter I received from the VP of Medical Rehabilitation Services & Continuing Care California Hospital Association, March 26, 2007 12:10PM

"Many of you may already have heard the good news-CMS has rescinded Transmittal 65/Change Request 5405!
Transmittal 65 applied Part B policies to Part A hospital services, including the definition of qualified personnel. If this policy had become effective, physical therapy assistants who did not attend an accredited training program and obtained licensure by "challenging" the exam would have not been able to provide Medicare Part A hospital services. CHA CMRS, as well as many individual providers, had communicated to CMS their concern that this change was inconsistent with California licensure laws, would create undue hardship for many employees, and would disrupt patient care services.
As of this morning, CMS has sent a directive to their contractors that states: "The instruction CR 5405 is rescinded and will not be replaced at this time. Please discard all materials related to CR5405."
Thanks to everyone for your advocacy.

I'm sure we will hear more tomorrow after the meeting.
AB

AB said: I'd like to quote a letter I received from the VP of Medical Rehabilitation Services & Continuing Care California Hospital Association, March 26, 2007 12:10PM
"Many of you may already have heard the good news-CMS has rescinded Transmittal 65/Change Request 5405!
Transmittal 65 applied Part B policies to Part A hospital services, including the definition of qualified personnel. If this policy had become effective, physical therapy assistants who did not attend an accredited training program and obtained licensure by "challenging" the exam would have not been able to provide Medicare Part A hospital services. CHA CMRS, as well as many individual providers, had communicated to CMS their concern that this change was inconsistent with California licensure laws, would create undue hardship for many employees, and would disrupt patient care services.
As of this morning, CMS has sent a directive to their contractors that states: "The instruction CR 5405 is rescinded and will not be replaced at this time. Please discard all materials related to CR5405."
Thanks to everyone for your advocacy.
I'm sure we will hear more tomorrow after the meeting.
AB

Thanks AB for the good news. The people I work for have not given me ANY information. I keep checking this site for updates. Everyone's input has been helpful.

My bad, I had my transmittals mixed up, thanks Plano Tx for the clarification

Does anyone have any word on the outpatient restrictions and if that will also be overturned.

Where can one find official information of the rescinding of the policy concerning PTA's?

]I'd like to quote a letter I received from the VP of Medical Rehabilitation Services & Continuing Care California Hospital Association, March 26, 2007 12:10PM
"Many of you may already have heard the good news-CMS has rescinded Transmittal 65/Change Request 5405!
Transmittal 65 applied Part B policies to Part A hospital services, including the definition of qualified personnel. If this policy had become effective, physical therapy assistants who did not attend an accredited training program and obtained licensure by "challenging" the exam would have not been able to provide Medicare Part A hospital services. CHA CMRS, as well as many individual providers, had communicated to CMS their concern that this change was inconsistent with California licensure laws, would create undue hardship for many employees, and would disrupt patient care services.
As of this morning, CMS has sent a directive to their contractors that states: "The instruction CR 5405 is rescinded and will not be replaced at this time. Please discard all materials related to CR5405."
Thanks to everyone for your advocacy.
I'm sure we will hear more tomorrow after the meeting.
AB

Alice Knol said: Where can one find official information of the rescinding of the policy concerning PTA's?
]I understand official language will be published by Friday by CPTA/APTA and CMS. If you google R65BP you'll find the statement from CMS: "The instruction CR 5405 is rescinded and will not be replaced at this time. Please discard all materials related to CR5405.

we PTA has a great role in patient care. we all know that APTA does not support PTAs. The APTA vision 2020 is to iliminate PTAs in thee physical therapy world and be rehab aides. This is why they are pushing PTs with masters or BS degrees to take PHDs..This will make their income high and with PTAs out in the picture it will make it higher. Why do you think they are pushing to decrease our responsibilities as PTAs slowy? huh!!! We PTAs should come together and make our own association....This is our family we should protect it!!!

Great job everyone: Our voices were heard and logic seemed to have ruled the day. This was an important victory but let us not forget the stress and anguist we went thru and channel it in a positive and constructive way. Their are other issues out there and the quote "at this time" makes me abit nervous pertaining to CR 5405. Let`s keep this PTA forum active and someday soon the playing field will be level and we all can be proud to be in this wonderful profession we so dearly love.

Here's some information that those of you that live in So. Cal might be interested in: Cerritos College is planning a fast track program for PTA's that challenged the Board. It will be a 1 year program. They are having a meeting on Wed. April 11th at 8:00pm to explain about the program. This will be a ONE TIME OFFERING from the college. They are only accepting 35 people in the program and I was told that if they have little interest it won't be offered at all! We all know that Medicare can and probably will try this again in the near future. This is our opportunity to safegaurd our careers! The Program Director is Maryjean Piorkowski,PT,MS,DPT and her phone (562-860-2451 ext. 250). If you have been considering this, now is the time.

Thanks PTA in Lake Forest, I just rec'd the info in the mail for Cerritos,see you on4-11.

Is there a school up here is No. Cal? I know this will surface again.
Thanks for all the good info everyone provided during this awful time for all us.

I have been following this issue with great interest. I was wondering if anyone on this message board has contacted APTA Government Affairs to see what action has been taken on this issue.
Also, I would like to recommend a great resource available for PTA's on the APTA website - a message board designed exclusively for PTA's. APTA membership is required to access the message board.

Luke Markert
PTA Caucus Representative - Texas

APTA is on our side! This is from the APTA website.

Medicare Withdraws Inpatient HospitalPolicies
The Centers for Medicare & Medicaid Services (CMS) this week rescinded Transmittal 65, which would have revised Medicare policies to require inpatient hospital therapy services to conform to the same policies that apply to outpatient therapy services, with certain exceptions, effective April 1. The CMS action means that the policy in its entirety has been withdrawn for further consideration and no action will need to be taken by providers with regard to the requirements of the Transmittal (reviewed for members in "Summary of Revisions: Therapy Services in Inpatient Hospitals" on the Medicare Web page).

APTA and other organizations will be working closely with CMS officials to ensure that any further policy changes will not be administratively burdensome or negatively affect the delivery of care. The Association will update members regarding further developments on this issue.

_________________________________________

LM_PTA said: I have been following this issue with great interest. I was wondering if anyone on this message board has contacted APTA Government Affairs to see what action has been taken on this issue.
Also, I would like to recommend a great resource available for PTA's on the APTA website - a message board designed exclusively for PTA's. APTA membership is required to access the message board.
Luke Markert
PTA Caucus Representative - Texas

i am surprised that nobody mentioned any attempts to contact ACLU and Dateline about this matter. We are not second class citizens we need to have our voices heard now and to prevent any future attemppts to "railroad" us and our patients

That is the rub about the APTA website keeping us informed. We are not members of the APTA-they do not recognise us. Maybe some of you that read this can keep us informed of what the APTA message board states since we can not read if for ourselves.

Mary T. well put! The APTA could care less about us, but they would take our money.

Let's not turn our success into polemics about what can they do further or what's next? We have to organize ourselves by creating our own association> In this way we can show how many of us we are and that we are united. Seriously, does anybody know somebody at ACLU? Or DatelineNBC our problem it's a reflection on how poorly CMS manages OUR ( yes, ours)money from Medicare and how easy it's for them to screw one more time, our elderly I work in SNF and honestly nobody said anything to us it looks that SNF were not affected`this time but doesn't matter probably SNF's would have been next i came from a comunist country and this incident opened deep wounds into my soul again i felt that nobody care for the honest working people and that the situation was helpless. Let's admit it RPT's don't like us us as PTA's and worst of all us as THE CHALLENGED ONES. Me again

I would agree Daniel and Mary T. The APTA doesn't really want us as members because they don't really want us. They protected us this time because they new that there were not enough PTA program grads around to fill the need, and that becuase they are pushing for the DPT so badly, they need to keep points with the PT's that are against it.

I don't want to diminish the role that the APTA played in recinding of CMS transmittal 65, but if the APTA was so strong and powerful...how did it happen in the first place, and why did we find out only 2 weeks prior.

Since the transmittal was recinded it is hard to fight against something that no longer exists. We just need to stay informed, and be ready to call on our leaders if it smells like this might happen again.

I am happy that this forum exists, and I look forward to all comments.

If the inpatient section was overturned as being wrong then why was the outpatient restriction not overturned at the same time? Shouldn't the same rules apply to both?

You are right Dave The difference is that people really misread the transmittal It says that PTA has to be a graduate of a 2 yrs program OR 2 yrs experience as PTA and licensure by a state So to everybody's surprise we still have PTA in outpatient clinics treating Medicare patients and they got their licenses through equivalency Do you know why? because their employers read the law and applied it corectly

Mary T said: That is the rub about the APTA website keeping us informed. We are not members of the APTA-they do not recognise us. Maybe some of you that read this can keep us informed of what the APTA message board states since we can not read if for ourselves.

Mary,
Why aren't you a member of APTA?

I have been in PT since 1979, first as an aid and then I challanged the test here is California. Passed the first time round with a number that made me think they graded the wrong test. I am old,I have done my share of grunt work, 20 years in one hospital, s5 years in SNFs and now OP. When you look at new grads, I work in OP because my HMO has a no lifting clause. (when you are no spring chicken, things like this are very important!)

I spoke with a woman at the PTBC who said they too were blindsided by the Medicare ruling, not forewarned nor asked their opinion. The woman was quite nice, told me to access this forum, and contact Dorothy Shannon at CMS. The PTBC disagrees with CMS ruling. I am not a PTA, but am trying to put my 2 cents in as a fellow PT worker.

Actually, at my work, an outpatient clinic, no PTA who challenged the test has been able to work with MEdicare patients since it came out last year.

KF
We need all the info we can get. I have e-mailed Ms. Shannon several times, no answer but no wonder. My gut tells me this will not be put under the carpet for long and it will resurface again. I feel we all need to stay on top of this issue and continue to write everyone until there is something cut in stone.

When I started this chat room 1 month ago I envisioned that I was not the only one out their affected and if we come together and have our voice heard we could bring about a change and we did! But until their is permanent language that staes we are equal and deserving we will continue to have to fight to be recognized. I am going to cerritos college to protect my livelihood and until we have a grandfather clause and will be able to work with outpatients,I suggest you do the same. I don`t trust anyone with my family income. I pray that PTA`s who do not and can not go to school to contact lawyers, congressman, or any public offical or TV network to put pressure on Medicare, APTA, and our state board to put an end to this and stop challenged exams if it going to cause a limited license which we all know what is being really issued. Again that all of you for your participation and I will continue to stay in touch. I will see some of you at Cerritos.

Was nice meeting all of you guys last night. God for sure has a special place in heaven for Mrs. Piorkowski and for you Nathan God bless you both for puting this together hope to see al of you in may 22 take care

NMin Los Angeles, California said: When I started this chat room 1 month ago I envisioned that I was not the only one out their affected and if we come together and have our voice heard we could bring about a change and we did!

This is one of the best examples of why we at Indeed host these forums. Thank you all for your support of one another and good luck!

It turns out that Dorothy Shannon is not in the right department for dealing with the Part B change, but made some good suggestions towards trying to lobby for a across the board consistent definitiion of qualified personnel. Part A which had transmittal 65 rescinded allows PTAs who challenged the test to be reimbursed, but until Home Health faces the same policy change, the federal order that changed for outpatient can't be easily changed. However, when HOme health is up for review, mandating for a consistent definition for all Medicare sections would allow Part B's change to be rescinded. However, it depends on our illustrious APTA to work for it, and as a non-member, my comments to their lobby department were ignored b/c they only are interested in those who pay their dues. So, if any of you are dues members, try that approach for changing Part B.
Also, Sac City College in Northern Cal, is considering an accelerated program for challenging PTAs.

I just sope to Ms. Dorothy Shannon, 410 786-3396. She is the person who helped to recind the transmittal. She said to keep our eye on the APTA board. When I informed her that I was not able to be a member, her reply was "That should tell you something." So, all of you who work with APTA members, have them stay up on this issue. California is not one of her pet projects, to say the least about that. She states there is no new transmittal at this time. True or not, that is what she said. The implication was there that it would surface again.
Beth at Sacto City College is a real sweethart. She is also working on something that will help us. It is on the web and she it putting together a mailing for interested parties. I don't have her number here or I would post it.
Good Luck to all of us, the Feds are not our friend in this matter.
Mary

I have been licensed for 6 years and as of 2 weeks ago I knew nothing of this stuff. What is the understanding of Physical therapist
assistants (licensed by equivelancy) working with medicare pt.s in the out patient setting?
Don

There is a meeting on May 10 at Cedars-Sinai Medical center at 6:00pm Los Angeles. RSVP Lorraine Kimura at 310-423 5497 or Sal Abiera at 626-536-0126 concerninig Legislative,and recent CMS changes affecting our pratice. This is a great opportunity to get information and to let the APTA know our position. I strongly advise every PTA board challenged person to try to attend.