As described in a posting on March 21, the Texas Physical Therapy Association met with representatives from Trailblazer Health. Trailblazer has agreed to accept additional provider commentary on the current LCD ( http://www.trailblazerhealth.com/lmrp.asp?ID=2988&lmrptype=va  ) for a finite period of time. The VPTA, TPTA and other states impacted by the LCD are working together to gather information to assist them in understanding the impact that the LCD will have on providers and patients if it is maintained in it's current format.

The VPTA reimbursement committtee is accepting input from the VPTA membership regarding any portions of the current LCD that could inhibit your ability to provide the best care possible to your patients. These comments should be as specific as possible with clinical examples if appropriate. You may reference the minutes  from the TPTA Trailblazer meeting ( see March 21 listserv entry) for a listing of the issues that the TPTA expressed as areas of concern. This may be a good starting point in thinking about your comments.

Your comments should include:

• The portion (s)  of the LCD that to which your comments relate
• The issue, with clinical examples if appropriate
• A suggestion of a better alternative
• If you are responding for your clinic, how many clinicians your response represents.

COMMENTS ARE BEING ACCEPTED  IMMEDIATELY. ALL RESPONSES MUST BE RECEIVED NO LATER THAN APRIL 21.

Please submit comments and/or questions via email by responding to this listserv posting or directly to angelasbrooks@...

Thanks for your prompt attention to this matter.

The Reimbursement Committee

Dear fellow VPTA members:

I will be volunteering as a physical therapist and guest lecturer at Da Nang
Orthopedic & Rehabilitation Center in Da Nang, Vietnam, from May 17 to July 6,
2006, with Health Volunteers Overseas to assist in training the local physical
therapists, students, doctors, and staff in evaluations and treatment techniques
often used in the U.S.A.

The clinic provides care to all patient's regardless of ability to pay and is in
need of some basic rehabilitation supplies.  Also, the physical therapy students
and PT staff would appreciate textbooks specifically with pictures...most are
unable to speak/read English.  The wish list is as follows:

- hot packs
- Theraband
- Exercise book w/pictures
- Bicycle or motorcycle helmets (to prevent TBI's which is a BIG problem)
- splinting materials
- AFO's
- electrodes and wires, portable EMS machines
- resting splints, good hemislings for severe subluxed shoulders, edema glove
for the hand, stockinette
- abdominal braces, back corsets or Jewitt type brace, rigid neck collars
- Zimmer splints to keep knee extension in standing; or KAFO type splints for
training
- balance retraining cushions or foams, Sissl type cushions;
- stroke rehab furniture (wheel walkers, platform walkers, quad canes, stools on
wheels, different height stools and boxes
- slings and springs for suspended exercises (they have a grid)
- wheelchairs, seat cushions, lay trays (inpatients all share 1-2 wheelchairs
for portering only)

Any donation no matter how small would be appreciated and is TOTALLY TAX
DEDUCTIBLE...just let me know how much the item cost or, if its used, the
estimated value, and I will get an official letter from health volunteers
overseas with their tax code for your tax deduction when I return.

If you are interested in making a donation, please bring it along with you to
the VPTA retreat at Smith Lake in April or give it to your district leader who
will be attending and I will pick it up there.  If you are in the northern
district and will not be attending, I can make plans with you to pick it up and
your work or home...please call or email me at the number/address below.

Thank you all in advance for your help.  I hope to take lots of picture and will
have a album made for all to view.

Sincerely,

Lori Alexander, MSPT
VPTA Northern District Membership Chair
(703)619-9409
lalexan2@...

Trailblazer Health Enterprises, LLC has recently sent out a guide to
assist you in supplying the information required to obtain a manual
exception to the recently enacted Medicare Therapy Cap. This
document will soon be posted in the reimbursement section of this
website and can be accessed at
http://www.trailblazerhealth.com/partb/downloads/TherapyCapExceptionR
equestForm.pdf

Please note, this information was received by all members who are
currently signed up for the Trailblazer Listserv. If you are not
signed up to receive these notifications by way of the listserv, you
are strongly encouraged to do so. You can access the sign up feature
by going to www.Trailblazerhealth.com and clicking on the area on
the right side of the screen.

Given the issues that have arisen as of late stemming from the
modified Trailblazer LCD and the Medicare Therapy Exception process
you are advised to check this listserv frequently for important
updates.

Thanks.

In early March, our counterparts in Texas, the Texas Physical
Thearapy Association, met with several representatives from
Trailblazer Health. In their meeting they discussed the new
requirements set forth by the LCD and the therapy cap. The following
information is taken directly from their meeting summary which was
reviewed and approved for accuracy by Trailblazer Health. Please
review, there are some very interesting points made regarding the
ICD 9/procedure crosswalk that was put into play the by the new LCD.

Also, do not forget the teleconference tomorrow with Trailblazer
Health during which many of these topics will be discussed. The call
in information can be found in the previous message from
payerrelationsspecialist.

________________________________________________________________

Representatives from Trailblazer Departments with specific authority
over
Physical Medicine & Rehabilitation (Therapy Services ) under Part B
MPFS
in Delaware, Maryland, Virginia, Washington D.C. & Texas

• Manager of Coverage Policy (1)
• Manager of Medical Policy (1)
• Manager of Medical Review (1)
• Medical Directors (2)
• Provider Outreach Education Trainer Specialist (1)
• Specialists, Coverage Policy (2)



Representatives from Texas Physical Therapy Association

• PT , PP Owner & Federal Governmental Affairs Committee Liaison (1)
• PT, Former PP Owner & Reimbursement & Compliance Consultant (1)
• PT, Reimbursement Chair, TPTA (emergency excused absence)




Meeting Focal Points

Trailblazer's Local Coverage Determination for P M & R


1) Trailblazer `s LCD Reconsideration Process handout was provide to
us to
review and use for any subsequent formal revisions/comments


  Comment: Medical Review, Manager stated that her department would
open

  an informal input window to allow providers to submit comments and

  recommendations on/for:

a) Diagnosis that are absent from either or both the `suspended'
Trailblazer
LCD and the CMS ICD-9 List
b) CPT Code Description & Bifurcated Code (97140)
c) Frequency Directive at Modality/Procedure Level that have
conflicting
directives for passive and active interventions (25% passive
expectation
e.g.16 modality services/month and 12 procedure services/month)
d) Two-Month Duration `Expectations' set by Trailblazer for non-
neurological
musculoskeletal conditions to incorporate therapeutic rationale for
including post operative and other healing time in the episode
e) Service/Unit Utilization Guideline conflicts with diagnostic
categories (1-
01-06 diagnosis to procedure crosswalk and CMS exceptions)


  ACTION: TPTA representatives will contact the other therapy
jurisdictions to
determine interest in forming a Task Force to provide comments
and input regarding the LCD's to Trailblazer


2) Trailblazer's LCD Status
a) LCD will remain enforce as the PMR Guiding Tool
i) Medical Review for medical necessity
ii) Claims edit guidance
b) LCD components edits suspended (2-3 month evaluation period):
i) Procedure to Diagnosis Edit (limited coverage crosswalk)
ii) Utilization Guidelines (will continue to be considered if under
Medical
Review necessitated by questionable or aberrant billing practices)

Comment: TPTA participators commented on the inconsistencies
noted among the Utilization Guideline requirements, the 1-1-06 LCD
limited coverage crosswalk and the CMS Therapy Cap Exceptions;
Trailblazer appeared willing to review and rectify

Comment: Per Trailblazer participants: CMS expects contractors to
have Limited Coverage (procedure to diagnosis edits) crosswalks in
place, therefore, Trailblazer will be evaluating how it will modify
its
current crosswalk/edits to include the CMS Exceptions as well as to
provide consistent education and edit tools

c) CMS Therapy Cap Exception Requirements will be fully employed
including, but not limited to, the ICD-9 Conditions and Complexities
d) Exception Process to be implemented by 3-13-06 and posted 3-10-06


3) Documentation Requirements
a) All medical necessity documentation guidelines remain in effect
per
Transmittal 36/CR 3648 unless in conflict with Transmittal 47/CR4364
requirements which will then supersede any previous requirements


4) ICD-9 & Proper Claim Coding
a) CMS Transmittal 735/CR 4097 is the recommended tool for billing
guidelines
b) Medical ICD-9 / Functional and/or Therapeutic ICD-9's
i) Trailblazer indicated that PTs should code to the Greatest Level
of
Specificity regardless of diagnostic category
ii) Trailblazer indicated that PTs should use Medical rather than
Rehabilitation/Intervention diagnosis when coding claims. They
stated
that they would expect to see all diagnosis relevant to the
treatment on
the claim (in cases where there are more than four diagnosis
Trailblazer would expect to see the remaining ones documented in the
clinical record)
iii) Trailblazer clarified ICD-9s coding directives for claims
filing stating
that we could use up to (four) 4 diagnoses1 (Medical/Co-Morbidity/
Rehab) in Item/Box 21 on the 1500 or equivalent 837 1(soon to be 8)
iv) Trailblazer stressed that only one (1) diagnostic code could be
use in
Item/Box 24 E
v) Trailblazer reiterated that multiple units of the same CPT code
must be
entered on the same line (24G) if performed on the same date of
service
vi) Trailblazer clarified the Item/Box 19 requirement for : Date
Last Seen
(DLS) and UPIN number; Trailblazer only looks for a `valid date' and
UPIN, they expect that the DLS represents the last time the patient
was seen by his/her attending; it is not the Plan of Care or
Referral
date unless they are actually the DLS. Its purpose is to validate
that
the patient is under the care of the doctor and that (per
Transmittal
735) a certified or re-certified Plan of Care is being maintained on
file
Problems Discussed: Single diagnosis per Item 24G/DOS when
two separate and distinct diagnoses are being managed on the same
DOS and procedure frequency limitation per DOS or per condition

Comment: Trailblazer expressed understanding and concern, but no
immediate resolution other than entering the opportunity to enter a
"Unusual Circumstance" note" in the electronic comment field
indicating the two diagnoses for situations such as: same procedure,
2
units of 97110 for the knee and 2 units of 97110 for the shoulder on
the
same date of service

vii) Trailblazer stated that 2006 LCD Y-18B-R1 only pertained to the
97000
series CPT codes listed and that this did NOT mean these were the
only CPT codes available to PTs. They did state PTs would need to
follow the rules established for whatever codes we billed outside
the
97000 series and be familiar and comply with any related LCD's for
those areas

5) Medical Necessity
a) The LCD will still be the guiding document for reviewers:
b) Medical necessity policies will be based on information provided
by the
CAC, NCD and other reliable sources
c) Provider documentation (per CR 3648 & CR 4364) to support
coverage &
policy requirements is a requirement for all claims submission
whether for
routine and or `excepted' claims
d) Provider signature on claim or manual request is an attestation
that proper
and adequate documentation to support the claim is present, prior to
the
filing of the claim
e) Providers can be subject Progressive Correction Action resulting
in
placement into the Local Provider Education Training (LPET) program
or
placement on pre-payment review if analysis of data reveals
potential or
actual documentation problems

6) Claims Denied for Limited Coverage (Procedure to Diagnosis
Crosswalk) from the January 1, 2006 LCD
a) Claims with Dates of Service from January 1, 2006 and January 2,
2006
must use the Redetermination Process and suggest using form CMS
20027
b) Claims with Dates of Service from January 3, 2006 through March
13,
2006 there will be two options for dealing with these denials
i) Option I: Resubmit the Claim (must be for DOS after 1-2-06
ii) Option II. Use the Redetermination Process noted below in 7(iii)

7) Claims Denied for Exceeding the Cap Prior to Exception Process
a) Claims denied for exceeding the Cap that would have qualified for
an
automatic exception
Procedure: Re-file the claim with a KX modifier
b) Claims denied for exceeding the Cap that would not have qualified
for an
automatic exception but that might qualify as a manual exception
Procedure: Follow the exception process outlined by Trailblazer on
the
following link: http://www.trailblazerhealth.com/notices.asp?
action=detail&id=3547
i) Must be a written/signed request for a re-opening for the denied
claim
ii) May be submitted on the CMS 20027 (Redetermination Form) but
must minimally include:
(1) Provider name*
(2) Medicare provider number*
(3) Beneficiary name*
(4) Health insurance Claim (HIC) number*
(5) Contact name and telephone number
(6) Indicate if this is for a manual exception request or
retroactive
reopening
(7) Required supporting documentation:
(a) Number of treatment days requested
(i) Number of retrospective days requested
(ii) Number of prospective days requested
(b) Evaluation and certified Plan of Care
(c) Re-certifications and re-evaluations (if applicable)
(d) Progress reports
(e) Treatment encounter notes (incl. flow sheets, etc.)
(f) Justification documentation (part of or separate documents)
iii) Submit requests for manual exception to: Fax (800) 592-536
iv) Requests for reopening should only be submitted for
medically necessary services that have been denied for
exceeding the cap and do not meet the automatic exception
v) Requests for manual exceptions should be submitted when
the patient is nearing the cap limit and does not meet the
requirements for an automated exception but the provider
believes it is medically necessary for further therapy services.
Fax these requests with all of the documentation outlined in
Transmittal 47 Pub. 100-02.
www.cms.hhs.gov/transmittals/downloads/R47BP.pdf

Appeals Process

• Re-opening for minor errors
o Does not eliminate the right to appeal subsequent submissions
o Must be written and should (recommended) use CMS 20027
o Does not require clinical records to be submitted


• Redetermination – claim denied due to lack of medical necessity
o Is typically considered the first level of appeal
o Must be written and should (recommended) use the CMS
Redetermination Form CMS 20027
o Requires full medical records submission for all dates of services
denied


• Reconsideration—
o Processed by Qualified Independent Contractors (QIP)
o Replaces the Fair Hearing
o Must be written per QIP directives
o Requires clinical records and all documents requested


• Administrative Law Judge
• Appeal Board
• Federal Court


These Minutes have been read and approved by Trailblazer Health and
should not be modified without the expressed permission of
Trailblazer
and/or TPTA.


Submitted by Mary R. Daulong, PT/CHC & Bobbie Hurt, PT

Texas Physical Therapy Association 3-17-06

* As of March 13, medicare therapy providers may begin to obtain
exceptions to the $1740.00 cap that went into effect January 1, 2006.

* APTA held an audio conference on The New Therapy Cap Exception
Process on March 15. If you were unable to participate you may obtain
a copy of the session on disc after March 31. Please access the APTA
website to obtain this valuable information.

* Trailblazer Health Enterprises will host a physical therapy
teleconference to educate providers further on the Medicare Therapy
Cap Exception Process on March 21, 2006, 2:00 pm EST. There is no
registration required. The access number is 1-800-726-4717.

* Trailblazer Health Enterprises has established a new toll free fax
number for reopening and manual extension requests.
1-800-592-0536.

* Keep in mind, the APTA website is a fabulous resource for all
members as they strive to understand this arduous process. I encourage
you to take advantage of the wonderful legwork our national
association has done for us.

The message below has been crafted by Debbie Kelly, Executive
Director of the Virginia Chapter of the APTA. This summarizes the
resources available to you to assist in better understanding the new
Medicare Therapy Cap and the extension process. Please make note of
the audio conference that is to take place on March 15 which will be
hosted by the APTA and designed to allow you to ask questions and to
hear questions posed by your peers also impacted by this change. If
you are unable to participate in the audio conference event, you
have the option of purchasing a CD of the conference for reference.

If you have any questions regarding obtaining access to the
information cited below, please email Angela Brooks at
AngelaSBrooks@....


Angela S. Brooks, P.T.
VPTA, Payer Relations Specialist

_____________________________________________________________________

Therapy Cap FAQs and Other Information Available Online

APTA has been receiving hundreds of calls on the new exceptions
process that will be implemented March 13 for the Therapy Cap and
has posted answers to many of the most frequently asked questions on
APTA's Web site at <http://www.apta.org/AM/Template.cfm?
Section=Therapy_Cap&DIRECTLISTCOMBOIND=D&CONTENTID=28860&NAVMENUID=52
8&TEMPLATE=/MembersOnly.cfm>.

These FAQs will be updated regularly as the Centers for Medicare and
Medicaid Services (CMS) moves forward with the implementation
process. Additional information regarding the Therapy Cap, including
information for patients (<http://www.apta.org/AM/Template.cfm?
Section=Therapy_Cap&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=28815>)
, a detailed summary of the exception process
(<http://www.apta.org/AM/Template.cfm?
Section=Medicare1&Template=/MembersOnly.cfm&NavMenuID=528&ContentID=2
8861&DirectListComboInd=D>), and links to the CMS transmittals
(<http://www.apta.org/AM/Template.cfm?
Section=Medicare1&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=28525>)
also are available.


Upcoming Therapy Cap Audio Conference

APTA will host an audio conference on "The New Therapy Cap Exception
Process & Documentation Requirements: What You NEED to Know" on
Wednesday, March 15, from 2:00 to 4:00 pm Eastern time. Expert
consultant Stephen M Levine, PT, DPT, MSHA, and Gayle Lee, JD,
Director of APTA Regulatory Affairs, will explain the new process
and respond to questions during the live call. For more information
or to register for this discussion, please visit
<http://www.apta.org/AM/Template.cfm?
Section=Federal_Regulatory_Affairs&TEMPLATE=/CM/ContentDisplay.cfm&CO
NTENTID=28866>.

>From: terry <taeng@...>
>Date: Tue Feb 14 05:29:35 CST 2006
>To: vpta@yahoogroups.com
>Subject: [vpta-listserv] Plz invite your legislators via email or phone call
today

>              Wednesday February 15, 2006
>                    9:00AM to 2:00PM
>            Keeping Virginians in Action
>                      Hosted by
>       The Virginia Physical Therapy Association
>                        and
>  Virginia Commonwealth University School of Physical Therapy
>   1st Floor Lobby of the Virginia General Assembly Building
>
>Please come and speak with nationally recognized leaders in the field of
Physical Therapy on the following topics:
>
>BIOMECHANICAL ASSESSMENT OF THE FOOT AND ANKLE: Learn more about your foot type
and gain valuable understanding regarding the most appropriate footwear for your
body.  At this station, you will receive a free biomechanical assessment by a
nationally recognized speaker and clinician.
>
>FUNCTIONAL MOVEMENT ASSESSMENT: Do you currently have a regular exercise
program?  Do you currently suffer from an injury?  At this station,
professionals who specialize in the area of Orthopedic Physical Therapy will
perform an injury prevention screening.  Participants will be offered a
biomechanical analysis that helps you find areas of joint stiffness, muscle
tightness and weakness.  It?s human nature to work on areas of the body that are
already strong or already flexible.  Improving our physical performance and
decreasing the risk of injury requires understanding of our weakness so that we
can create a more balanced body.
>
>RECENT RESEARCH INVOLVING ANKLE SPRAINS: Almost everyone has personally
experienced the pain, swelling and loss of function from an ankle sprain. 
However, the research shows that almost half of those individuals experience
recurrent injury to the ankle.  Why?  Physical therapy faculty member, Dr. Pete
Pidcoe, PT, will be onsite to discuss his recent research project involving
ankle sprains.
>
>PHYSICAL THERAPY HIGHER EDUCATION ACROSS THE COMMONWEALTH: Educators from
around the state will be available to discuss information regarding current
school curriculum.  Physical Therapy began in the early 1900?s.  Discover how
the profession has changed as it?s advanced to the doctorate level degree.
>
>Join us as we seek to Keep You in Action!  We aim to give back to you,
>who have given  your valuable time, energy and resources
>to improve the lives of the citizens of the Commonwealth of Virginia.
>
>
>Terry Izzo PT,PCS
>Legislative Chair
>Virginia Physical Therapy Association
>
>
>
>Yahoo! Groups Links
>
>
>
>


Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

Wednesday February 15, 2006
                     9:00AM to 2:00PM
            ?Keeping Virginians in Action?
                       Hosted by
        The Virginia Physical Therapy Association
                         and
   Virginia Commonwealth University School of Physical Therapy
    1st Floor Lobby of the Virginia General Assembly Building

Please come and speak with nationally recognized leaders in the field of
Physical Therapy on the following topics:

BIOMECHANICAL ASSESSMENT OF THE FOOT AND ANKLE: Learn more about your foot type
and gain valuable understanding regarding the most appropriate footwear for your
body.  At this station, you will receive a free biomechanical assessment by a
nationally recognized speaker and clinician.

FUNCTIONAL MOVEMENT ASSESSMENT: Do you currently have a regular exercise
program?  Do you currently suffer from an injury?  At this station,
professionals who specialize in the area of Orthopedic Physical Therapy will
perform an injury prevention screening.  Participants will be offered a
biomechanical analysis that helps you find areas of joint stiffness, muscle
tightness and weakness.  It?s human nature to work on areas of the body that are
already strong or already flexible.  Improving our physical performance and
decreasing the risk of injury requires understanding of our weakness so that we
can create a more balanced body.

RECENT RESEARCH INVOLVING ANKLE SPRAINS: Almost everyone has personally
experienced the pain, swelling and loss of function from an ankle sprain. 
However, the research shows that almost half of those individuals experience
recurrent injury to the ankle.  Why?  Physical therapy faculty member, Dr. Pete
Pidcoe, PT, will be onsite to discuss his recent research project involving
ankle sprains.

PHYSICAL THERAPY HIGHER EDUCATION ACROSS THE COMMONWEALTH: Educators from around
the state will be available to discuss information regarding current school
curriculum.  Physical Therapy began in the early 1900?s.  Discover how the
profession has changed as it?s advanced to the doctorate level degree.

Join us as we seek to Keep You in Action!  We aim to give back to you,
who have given  your valuable time, energy and resources
to improve the lives of the citizens of the Commonwealth of Virginia.


Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

Please be advised that Angela S. Brooks, formerly posting under
Thirdpartygal, will now post under Payerrelationsspecialist.

Thanks!

URGENT MESSAGE REGARDING TRAILBLAZER HEALTH FROM THE REIMBURSEMENT
COMMITTEE


Effective January 1, 2006 Trailblazer Health enacted a modified
Local Coverage Determination ( LCD). The most recent LCD contains
two major changes - the new Utilization Guidelines and a list of ICD-
9 Codes that Support Medical Necessity. This list or "crosswalk"
pairs specific CPT codes with specific ICD-9 codes. Recently,
therapy practices have began to report denials ( "Denial Code CO-50 –
  These are non-covered services because this is not deemed
a "medical necessity" by the payer") based on the new "ICD-9
crosswalk". It is IMPERATIVE that your office familiarizes itself
with both changes but most importantly the ICD-9 Code listing. These
denials are currently not being corrected through the re-opening
process by phone and require appeal through the redetermination
process. The APTA has been very active in responding to these
changes and in crafting information to assist you. More detail will
be sent to you in email format from your District Chairs which will
contain links to the current LCD, the ICD-9 Code Listing, and the
forms for initiating the redetermination process. Once you have
reviewed the email, if there are still questions, please contact
Angela Brooks at angelasbrooks@....

By now many of you have heard that our efforts to win Direct Access
and Term Protection at the Virginia General Assembly this year were
derailed at an unpleasant subcommittee fight on Monday night. While
the momentum of our grassroots helped to strength support for these
bills among the collective body, a small number of three delegates
(one of which was a chiropractor and another a physician) took
advantage of procedural rules to stifle debate and kill the bills
before they could be heard by the full committee. Anyone present at
the meeting would agree that some members of the subcommittee acted
un-statesmanlike and even lashed out at the proponents of our bills
-- refusing to allow potential compromises to be brought to the table
for debate.

Despite the success of the back handed methods of those mentioned above, the
merits of our bills were eloquently presented by Delegate Bill Janis, also a
member of the sub committee. It was apparent that Delegate Janis took the time
to educate himself on the facts and evidence ,presented to him by VPTA members
and patients, that dispelled the unsubstantiated accusations of our opponents.
Those of you that were present can attest to the fact that Delegate Janis
contributed a compelling, logical argument in support of our legislation.

The VPTA lobbying and grassroots efforts this year were extensive --opening
doors to new support for these measures and strengthening old allies. Our
lobbyists Richard Grossman, Myles Louria, Cathy France and the rest of the
Vectre Corporation did an outstanding job assuring that our grassroots efforts
were acknowledged. They referred to the VPTA’s legislative initiatives as “Our
bills” and communicated with us on a daily basis. Time and again legislators
commented on the excellent representation these individuals provided for our
Association. Response from VPTA members across Virginia was incredible. Over
3500 postcards were sent. One legislative aide commented that our bills
generated the most constituant response than any other bill before them this
session.

It was clear we have allies within the General Assembly ready to move these
measures forward and our grassroots/lobbying efforts underway will further our
position in the coming months.

As you know, it has been five years since VPTA brought forward
pro-active legislation challenging restrictions on direct access. In that time,
almost 50% the membership of the House of Delegates has changed. Given the steep
learning curve on these issues, and the formidable challenge our opposition
mounted against us, it would have been difficult to pass meaningful changes to
the PT practice act this session without giving up too much to our opposition.
However, we did make great strides this session and we now have a very good
picture of where our strengths lie and where more efforts are needed.

This could not have been done without putting the issue before the legislature.
Soon we will regroup and continue the fight -- but for now, I wanted to thank
those of you worked so hard these past few weeks. We need to be proud of our
team effort, and energized by the ready willingness of our patients to attest to
the professionalism and value of our services.

Terry

Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

First be advised that at this point in the process things can change moment to
moment.

At this point we have learned that our bills will go before the Health sub
committee 5:00PM Mon Feb 6, NOT Mon Jan 30. This is meant to give more time for
negotiations with the Orthopedic Society.

I will keep you informed if anything changes.

Our Grassroots efforts are alive and kicking1
We need to continue the momentum. We especially need folks from the Portsmith,
Hampton, Chesapeake area to contact Del Spruill, Del Algie Howell, Del
Hamiltone, Del BeCote.

Thank you



Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

>From: terry <taeng@...>
>Date: Tue Jan 24 05:44:46 CST 2006
>To: vpta@yahoogroups.com
>Subject: [vpta-listserv] Critical week to call your legislators!

>Our bills are going before the Health Sub Committe Mon Jan 29th
>
>We need a surge of calls, letters, and emails to get to legislators TODAY AND
EVERY DAY THE REST OF THIS WEEK ASKING THEM TO SUPPORT HOUSE BILLS 1112 (Direct
Access)
>
>Go to http://legis.state.va.us the Virginia GeneralAssembly web page for
legislator contact information.
>
>We especially need individuals who have one of the the legislators who make up
the Health sub committee to call. They include: Del Janis, Del Spirull, Del
Algie Howell, Del Moran, Del OBannon, Del Purkey, and Del Welch
>
>If you have already emailed or called thank you, and plz request your friends,
neighbors, colleagues (PT's and other health professionals) and patients who
have not, do the same.
>
>Legislators are hearing from the opposition. We cannot let them convince
legislators that patients are not safe if there was direct access to Physical
Therapy!
>
>Below is info youcan use to help coach folks not familier with the process:
>Heres the scoop re house bill 1112:
>
>Currently you can go to see a physical therapist for an evaluation but before
they can treat you, you would have to go back to see your Dr to get a
prescription. House bill 1112 would make it possible for you to get PT treatment
without always having to wait to get a prescription from you Dr first avoiding
delays and added expense.
>
>
>Chiropractors (who you don't need a prescription to see) are calling their
Delegates to say it would be unsafe to see a PT without seeing your Dr or them
first. This simply is not so and we have allot of studies that would support
this.
>
>When you call or write your delegate let them know you live in their district.
>If you are comfortable with it please share any personal stories about how you
have benefited from PT and how much easier it would be for you, if you felt it
was what you needed, if you could eliminate having to endure the unnecessary
time or expense to always see your Dr first.
>
>Just say how you feel or use some of the suggestins below to help you make your
point:
>
>As a consumer who is interested in having access to quality and convenient
health care choices, I would like the opportunity to go directly to a licensed
physical therapist should I feel that such care is in my best interest.
>
>Virginia is one of a few states that still restrict an individual from
obtaining physical therapy
>services without a referral from another licensed health care provider. A
majority of states have eliminated this restriction, which has given individuals
the liberty to obtain treatment from a licensed physical therapist without the
added time and expense of seeking out a referral.
>
>Potential to improve timely patient access to physical therapy is the primary
reason for eliminating the mandated referral from another licensed health care
provider.
>
>
>Eliminating barriers to patient access to physical therapist care would improve
timely delivery of services, diminish the impacts of disease on disability, and
promote earlier return to prior functional levels.
>
>Direct access to a physical therapist is part of the solution to developing a
more responsive and readily accessible health care model.
>
>Direct access to physical therapists also would offer possible cost savings to
patients. These cost savings could be achieved by fewer co-payments and doctor
visit charges to obtain a referral and timely options for non-pharmaceutical
interventions to treat their impairments.
>
>Potential patients will call the clinic for information about making an
appointment for care related to a musculoskeletal problem and are upset to
discover that they must first see the physician to gain a referral when they
have been talking to their personal trainer at the gym about this without any
medical referral at all.
>
>Direct access encourages patients to become more actively engaged in their own
decision-making and proactively address health care problems before they become
more significant and costly impairments.
>
>The potential for cost savings, improved access to healthcare, and empowerment
of patients to make proactive healthcare decisions all support the advisability
of making this change.
>
>
>Thank you!
>
>Terry Izzo PT,PCS
>Legislative Chair
>Virginia Physical Therapy Association
>
>
>Yahoo! Groups Links
>
>
>
>


Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

The last sentance of the paragraph after "Here's the scoop on Hb1112" should
read..."avioding delays and added expense" NOT "adding expense

>From: terry <taeng@...>
>Date: Tue Jan 24 05:44:46 CST 2006
>To: vpta@yahoogroups.com
>Subject: [vpta-listserv] Critical week to call your legislators!

>Our bills are going before the Health Sub Committe Mon Jan 29th
>
>We need a surge of calls, letters, and emails to get to legislators TODAY AND
EVERY DAY THE REST OF THIS WEEK ASKING THEM TO SUPPORT HOUSE BILLS 1112 (Direct
Access)
>
>Go to http://legis.state.va.us the Virginia GeneralAssembly web page for
legislator contact information.
>
>We especially need individuals who have one of the the legislators who make up
the Health sub committee to call. They include: Del Janis, Del Spirull, Del
Algie Howell, Del Moran, Del OBannon, Del Purkey, and Del Welch
>
>If you have already emailed or called thank you, and plz request your friends,
neighbors, colleagues (PT's and other health professionals) and patients who
have not, do the same.
>
>Legislators are hearing from the opposition. We cannot let them convince
legislators that patients are not safe if there was direct access to Physical
Therapy!
>
>Below is info youcan use to help coach folks not familier with the process:
>Heres the scoop re house bill 1112:
>
>Currently you can go to see a physical therapist for an evaluation but before
they can treat you, you would have to go back to see your Dr to get a
prescription. House bill 1112 would make it possible for you to get PT treatment
without always having to wait to get a prescription from you Dr first avoiding
delays and adding expense.
>
>
>Chiropractors (who you don't need a prescription to see) are calling their
Delegates to say it would be unsafe to see a PT without seeing your Dr or them
first. This simply is not so and we have allot of studies that would support
this.
>
>When you call or write your delegate let them know you live in their district.
>If you are comfortable with it please share any personal stories about how you
have benefited from PT and how much easier it would be for you, if you felt it
was what you needed, if you could eliminate having to endure the unnecessary
time or expense to always see your Dr first.
>
>Just say how you feel or use some of the suggestins below to help you make your
point:
>
>As a consumer who is interested in having access to quality and convenient
health care choices, I would like the opportunity to go directly to a licensed
physical therapist should I feel that such care is in my best interest.
>
>Virginia is one of a few states that still restrict an individual from
obtaining physical therapy
>services without a referral from another licensed health care provider. A
majority of states have eliminated this restriction, which has given individuals
the liberty to obtain treatment from a licensed physical therapist without the
added time and expense of seeking out a referral.
>
>Potential to improve timely patient access to physical therapy is the primary
reason for eliminating the mandated referral from another licensed health care
provider.
>
>
>Eliminating barriers to patient access to physical therapist care would improve
timely delivery of services, diminish the impacts of disease on disability, and
promote earlier return to prior functional levels.
>
>Direct access to a physical therapist is part of the solution to developing a
more responsive and readily accessible health care model.
>
>Direct access to physical therapists also would offer possible cost savings to
patients. These cost savings could be achieved by fewer co-payments and doctor
visit charges to obtain a referral and timely options for non-pharmaceutical
interventions to treat their impairments.
>
>Potential patients will call the clinic for information about making an
appointment for care related to a musculoskeletal problem and are upset to
discover that they must first see the physician to gain a referral when they
have been talking to their personal trainer at the gym about this without any
medical referral at all.
>
>Direct access encourages patients to become more actively engaged in their own
decision-making and proactively address health care problems before they become
more significant and costly impairments.
>
>The potential for cost savings, improved access to healthcare, and empowerment
of patients to make proactive healthcare decisions all support the advisability
of making this change.
>
>
>Thank you!
>
>Terry Izzo PT,PCS
>Legislative Chair
>Virginia Physical Therapy Association
>
>
>Yahoo! Groups Links
>
>
>
>


Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

Our bills are going before the Health Sub Committe Mon Jan 29th

We need a surge of calls, letters, and emails to get to legislators TODAY AND
EVERY DAY THE REST OF THIS WEEK ASKING THEM TO SUPPORT HOUSE BILLS 1112 (Direct
Access)

Go to http://legis.state.va.us the Virginia GeneralAssembly web page for
legislator contact information.

We especially need individuals who have one of the the legislators who make up
the Health sub committee to call. They include: Del Janis, Del Spirull, Del
Algie Howell, Del Moran, Del OBannon, Del Purkey, and Del Welch

If you have already emailed or called thank you, and plz request your friends,
neighbors, colleagues (PT's and other health professionals) and patients who
have not, do the same.

Legislators are hearing from the opposition. We cannot let them convince
legislators that patients are not safe if there was direct access to Physical
Therapy!

Below is info youcan use to help coach folks not familier with the process:
Heres the scoop re house bill 1112:

Currently you can go to see a physical therapist for an evaluation but before
they can treat you, you would have to go back to see your Dr to get a
prescription. House bill 1112 would make it possible for you to get PT treatment
without always having to wait to get a prescription from you Dr first avoiding
delays and adding expense.


Chiropractors (who you don't need a prescription to see) are calling their
Delegates to say it would be unsafe to see a PT without seeing your Dr or them
first. This simply is not so and we have allot of studies that would support
this.

When you call or write your delegate let them know you live in their district.
If you are comfortable with it please share any personal stories about how you
have benefited from PT and how much easier it would be for you, if you felt it
was what you needed, if you could eliminate having to endure the unnecessary
time or expense to always see your Dr first.

Just say how you feel or use some of the suggestins below to help you make your
point:

As a consumer who is interested in having access to quality and convenient
health care choices, I would like the opportunity to go directly to a licensed
physical therapist should I feel that such care is in my best interest.

Virginia is one of a few states that still restrict an individual from obtaining
physical therapy
services without a referral from another licensed health care provider. A
majority of states have eliminated this restriction, which has given individuals
the liberty to obtain treatment from a licensed physical therapist without the
added time and expense of seeking out a referral.

Potential to improve timely patient access to physical therapy is the primary
reason for eliminating the mandated referral from another licensed health care
provider.


Eliminating barriers to patient access to physical therapist care would improve
timely delivery of services, diminish the impacts of disease on disability, and
promote earlier return to prior functional levels.

Direct access to a physical therapist is part of the solution to developing a
more responsive and readily accessible health care model.

Direct access to physical therapists also would offer possible cost savings to
patients. These cost savings could be achieved by fewer co-payments and doctor
visit charges to obtain a referral and timely options for non-pharmaceutical
interventions to treat their impairments.

Potential patients will call the clinic for information about making an
appointment for care related to a musculoskeletal problem and are upset to
discover that they must first see the physician to gain a referral when they
have been talking to their personal trainer at the gym about this without any
medical referral at all.

Direct access encourages patients to become more actively engaged in their own
decision-making and proactively address health care problems before they become
more significant and costly impairments.

The potential for cost savings, improved access to healthcare, and empowerment
of patients to make proactive healthcare decisions all support the advisability
of making this change.


Thank you!

Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

This is a reminder that Justin Elliott, Associate Director, State
Government Affairs with the APTA has sent a statewide email to the
VPTA membership with an urgent request to submit input to your State
Delegate regarding this house bill that if supported will have
notable impact on Virginia physical therapists. The email contains a
link to a prepopulated form letter that is automatically sent to our
State Delegate. You also have the option to craft a personal email,
but the prepopulated format is a good first step.

Open the email from Justin, click on the highlighted link and do your
part to support direct access in Virginia.

And cudos to Terry Izzo for her tireless efforts in keeping everyone
informed on this and other vital professional issues.

To avoid any possible confusion from the email re HB 620 I sent out yesterday
this is not our bill. Our bills hb1111 and hb1112 are still very much alive and
kicking!

So keep e mailing and phoning your legislators...we have become a force that
cannot be ignored!

Below is the bill I referred to yesterday that was sent for further study and
will not be heard this session:This is a good thing for now. We will keep tabs
on it throughout the year.
HB 620 Physicians; definition of office practice.
Summary as introduced:
Physician self-referrals; definitions.  Amends the definition of "office
practice" as it relates to supervision of health care services.  The bill also
adds a definition for "same building," relating to such supervision.

Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

This bill will be carried over and looked at over the summer.

This means that it will not move forward during this session of the General
Assembly and no membership action is needed at this time.
Legislative committee will continue to keep tabs on it after session.

Most folks interested in this couldn't agree on what the bill actually did so it
won't move forward this session.
___




Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

>From: terry <taeng@...>
>Date: Mon Jan 16 19:20:17 CST 2006
>To: vpta@yahoogroups.com
>Subject: [vpta-listserv] Plz contact your legislator NOW!

>Plz read the following call to action in it's entirety:
>
>By now everyone should be aware that the General Assembly is back in Richmond
and will be voting on legislation which will impact Physical Therapy in a very
significant way.
>
>At the request of the Virginia Physical Therapy Association,
>legislation has been introduced that deals with direct access to PT
>services (HB 1112) and also restrict advertisements using the term
>"physical therapy" to only services provided by those licensed by the Board of
Physical Therapy (HB 1111).
>
>This legislation is an important step towards making safe and
>appropriate health care more accessible to more people. The referral mandate in
Virginia causes delays in the provision of physical therapists' services to
individuals who would benefit from our care.
>Delays in care can result in higher cost, decreased functional
>outcomes, and frustration to patients.
>
>WE NEED YOUR HELP IF THESE BILLS ARE TO PASS THIS SESSION AND ACTION IS NEEDED
NOW. Already legislators are hearing from opponents of these bills -- who are
casting doubt on our ability to evaluate and treat a patient without a referral.
They are also insisting that the term "physical therapy" is a term that can be
applied generically across health professions. You can help reinforce our
lobbying efforts to speak the truth and defend our profession by following these
few simple steps.
>
>STEP ONE: Access the General Assembly website to determine who is
>your Delegate and Senator in Richmond. Through this website, you are
>also given the opportunity to send a message to these legislators in
>support of our legislation.
>
>The website is: http://legis.state.va.us  (click on the "Who's my legislator?"
icon on the right-hand side under Quick Links.)
>
>Once you enter your name and address, click "LOOKUP" and your
>legislators information will be displayed. At the bottom of that page you are
given the option to "SEND A MESSAGE TO YOUR DELEGATE AND SENATOR".
>
>STEP TWO: One you have clicked "SEND A MESSAGE TO YOUR DELEGATE AND
>SENATOR", you are given a box to enter a message. Please fill out all of the
empty fields, such as your name, email address and subject line.
>
>Your message should be short and to the point. You are asking them to please
vote in favor of House Bills 1112 and 1111 which would give their constituents
the ability to access physical therapists'
>services without professional practice restrictions regarding
>referral and restrict using the term "physical therapy" in
>advertising to only services provided by professionals licensed by
>the Board of Physical Therapy.
>
>It would be helpful if you would describe your personal situation.
>Make a statement about how long you have been practicing physical
>therapy, where you practice, and how these bills would benefit your
>patients. Also mention that most states have not only recognized but have
eliminated this barrier to consumer access and choice. The US Armed Forces and
the US Public Health Service also have some form of direct access to physical
therapist services.
>
>Other points you may wish to include (depending on the flow of you
>letter) -- or you can expand on your own personal experiences with
>the need for direct access by your patients:
>
>+ Direct access can eliminate delays of service - waiting for a
>referral can take weeks
>
>+ PTs are educated at the post-baccalaureate level (all Virginia PT
>schools only offer a DPT degree) and receive extensive education and clinical
training to be able to practice without a referral. Most states allow some form
of direct access.
>
>+ Liability insurers affirm that direct access does not jeopardize
>the health, safety, or welfare of patients seeking PT services
>without referral.
>
>+ PTs are qualified to recognize when a patient's signs and symptoms are
inconsistent with or outside of their scope of practice and when the patient
should be referred to a physician. Current law in Virginia requires that a PTs
must immediately refer to the appropriate health care provider on these
occasions.
>
>+ Why should PTs continue to be required to work under a referral
>requirement when a referral is not required before receiving services such as
massage therapy, speech therapy, occupational therapy,podiatrists or
chiropractic services.
>
>+ This legislation would restrict advertising or promoting services
>by using the term "Physical Therapy" to only services rendered by a
>licensed physical therapist or physical therapist assistant under the direction
of a physical therapist. With the recent trends of emerging health professionals
and the growth of the fitness and health industry, physical therapy has been
misrepresented to the public.
>This term protection does not restrict any other licensed
>professional from working within their scope of practice. Given the
>education and licensure requirements of Physical Therapists, this
>legislation ensures the public that use of the term "Physical
>Therapy" is synonymous with physical therapists.
>
>If you receive any feedback, or you have a particularly close
>relationship with your legislators, please let our legislative chair know.
Terry Izzo can be reached via: "taeng@..."
>
>If I haven't emphasized this enough, I'll say it again -- we can't do this
without your help and we need that help NOW. These bills could be voted on
within days, and it takes time for legislators to look at and react to their
correspondence. Please take the 10 minutes or so that is needed to TAKE ACTION
RIGHT NOW!
>Thank You
>
>Terry Izzo PT,PCS
>Legislative Chair
>Virginia Physical Therapy Association
>
>
>
>Yahoo! Groups Links
>
>
>
>


Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

Thanks!

Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

Plz read the following call to action in it's entirety:

By now everyone should be aware that the General Assembly is back in Richmond
and will be voting on legislation which will impact Physical Therapy in a very
significant way.

At the request of the Virginia Physical Therapy Association,
legislation has been introduced that deals with direct access to PT
services (HB 1112) and also restrict advertisements using the term
"physical therapy" to only services provided by those licensed by the Board of
Physical Therapy (HB 1111).

This legislation is an important step towards making safe and
appropriate health care more accessible to more people. The referral mandate in
Virginia causes delays in the provision of physical therapists' services to
individuals who would benefit from our care.
Delays in care can result in higher cost, decreased functional
outcomes, and frustration to patients.

WE NEED YOUR HELP IF THESE BILLS ARE TO PASS THIS SESSION AND ACTION IS NEEDED
NOW. Already legislators are hearing from opponents of these bills -- who are
casting doubt on our ability to evaluate and treat a patient without a referral.
They are also insisting that the term "physical therapy" is a term that can be
applied generically across health professions. You can help reinforce our
lobbying efforts to speak the truth and defend our profession by following these
few simple steps.

STEP ONE: Access the General Assembly website to determine who is
your Delegate and Senator in Richmond. Through this website, you are
also given the opportunity to send a message to these legislators in
support of our legislation.

The website is: http://legis.state.va.us  (click on the "Who's my legislator?"
icon on the right-hand side under Quick Links.)

Once you enter your name and address, click "LOOKUP" and your
legislators information will be displayed. At the bottom of that page you are
given the option to "SEND A MESSAGE TO YOUR DELEGATE AND SENATOR".

STEP TWO: One you have clicked "SEND A MESSAGE TO YOUR DELEGATE AND
SENATOR", you are given a box to enter a message. Please fill out all of the
empty fields, such as your name, email address and subject line.

Your message should be short and to the point. You are asking them to please
vote in favor of House Bills 1112 and 1111 which would give their constituents
the ability to access physical therapists'
services without professional practice restrictions regarding
referral and restrict using the term "physical therapy" in
advertising to only services provided by professionals licensed by
the Board of Physical Therapy.

It would be helpful if you would describe your personal situation.
Make a statement about how long you have been practicing physical
therapy, where you practice, and how these bills would benefit your
patients. Also mention that most states have not only recognized but have
eliminated this barrier to consumer access and choice. The US Armed Forces and
the US Public Health Service also have some form of direct access to physical
therapist services.

Other points you may wish to include (depending on the flow of you
letter) -- or you can expand on your own personal experiences with
the need for direct access by your patients:

+ Direct access can eliminate delays of service - waiting for a
referral can take weeks

+ PTs are educated at the post-baccalaureate level (all Virginia PT
schools only offer a DPT degree) and receive extensive education and clinical
training to be able to practice without a referral. Most states allow some form
of direct access.

+ Liability insurers affirm that direct access does not jeopardize
the health, safety, or welfare of patients seeking PT services
without referral.

+ PTs are qualified to recognize when a patient's signs and symptoms are
inconsistent with or outside of their scope of practice and when the patient
should be referred to a physician. Current law in Virginia requires that a PTs
must immediately refer to the appropriate health care provider on these
occasions.

+ Why should PTs continue to be required to work under a referral
requirement when a referral is not required before receiving services such as
massage therapy, speech therapy, occupational therapy,podiatrists or
chiropractic services.

+ This legislation would restrict advertising or promoting services
by using the term "Physical Therapy" to only services rendered by a
licensed physical therapist or physical therapist assistant under the direction
of a physical therapist. With the recent trends of emerging health professionals
and the growth of the fitness and health industry, physical therapy has been
misrepresented to the public.
This term protection does not restrict any other licensed
professional from working within their scope of practice. Given the
education and licensure requirements of Physical Therapists, this
legislation ensures the public that use of the term "Physical
Therapy" is synonymous with physical therapists.

If you receive any feedback, or you have a particularly close
relationship with your legislators, please let our legislative chair know. Terry
Izzo can be reached via: "taeng@..."

If I haven't emphasized this enough, I'll say it again -- we can't do this
without your help and we need that help NOW. These bills could be voted on
within days, and it takes time for legislators to look at and react to their
correspondence. Please take the 10 minutes or so that is needed to TAKE ACTION
RIGHT NOW!
Thank You

Terry Izzo PT,PCS
Legislative Chair
Virginia Physical Therapy Association

CMS is proposing that new quality standards be implemented for any
provider of DME, prosthetics or orthotics. These changes will
negatively impact physical therapists who currently provide these
items as a part of their practice. The APTA is requesting member
commentary be sumbmitted to CMS to oppose this change. Go the the APTA
website, APTA in ACION - "Comment Now on DME Quality Standards". This
site will provide a synopsis of the issue as well as suggestions for
commentary format. Responses must be received by CMS no later than
NOVEMBER 28.

Dear VPTA Member;

If you have registered and/or are planning on attending the annual VPTA
meeting next week in Portsmouth, VA. the deadline is fast approaching for
registering for the wine tasting Thursday evening  and PAC luncheon on
Friday.  The wine tasting is $35.00.  The PAC lunch is $30.00.  Our
deadline for placing food orders is coming up in the next few days.
Please make the check out to VPTA PAC and send it to
Sydney Sawyer, PAC Treasurer
11907 Henderson Court
Clifton, VA 20124-2200

Thank you,
 George Maihafer, Chair
School of Physical Therapy
Old Dominion University

The following request is coming from the Virginia DMAS (Department
of Medical Assistance Services). They indicate that they would like
the VPTA to provide feedback by Sept 15th thus we need to hear from
our members ASAP. Please email your comments to rita Wong
(rwong@...) and cc Angie Brooks angelasbrooks@...
so we can formulate a response on behalf of the state.

From DMAS:
Please review this draft regulation revision and give us feedback as
to whether or not you feel your association members would have any
concerns about this revision.

"Physical therapy, occupational therapy, and speech-language
pathology services provided in outpatient settings of acute and
rehabilitation hospitals, rehabilitation agencies, or home health
agencies shall include an evaluation visit for each ordered
rehabilitative service for each patient per fiscal year, regardless
of whether the patient has received services from another provider
in the same year.  If services beyond the evaluation visit are
determined by the physician to be required, then the provider shall
request prior authorization from DMAS or its designee for additional
services."

Previously, the outpatient rehabilitation state regulations allowed
five therapy visits before prior authorization was required.  The
five visits include the evaluation and four visits.  The above
wording would replace the current existing regulations, if approved.

Thank you!
Rita Wong EdD, PT
PT Department Chairperson
Professor of Physical Therapy
Marymount University

Greetings.  On September 14, 2005 there will be a live audio
conference sponsored by the APTA with Medicare representatives to
discuss new Medicare physical therapy payment policies. I will be
taking part in this event as the VPTA Payer Relations Specialist and
urge you to communicate with me any issues, questions, concerns that
you wish to be voiced during this event. I would appreciate receiving
feedback no later than noon on September 13 such that I can organize
the topics that need to be addressed. I will communicate a
summarization of the event via the VPTA website. Remember you are also
welcome to participate in this event or you can purchase the audiotape
after September 14.You can find our more by logging onto the APTA
website. Thanks for any input you wish to share.

August 30, 2005

Dear VPTA member,


       I  would like to extend a special invitation to you, and your friends
and  colleagues,  to  participate  in the Second Annual Fall Winetasting to
benefit   the   Virginia  Physical  Therapy  Association  Political  Action
Committee.  It  will  take  place  Thursday,  October 20, 2005 (the evening
following  our  Board of Director’s meeting) from 7:00 PM to 9:00 PM at the
home  of George Maihafer. George’s home in Norfolk resides on the Lafayette
River  which will offer a unique and scenic setting for this event.
       The  evening’s  activities  will include a wine tasting
“competition”
between  of  wines  from  France  and  Australia presented by renowned wine
educator  and columnist Layne Witherell. Layne is reprising his role as our
“master   of  ceremonies”  from  last  year  and  promises  to  be  equally
entertaining.  Heavy hors d’oeuvres will be served to compliment the wines.
Transportation  is being planned for those participants who need it between
the conference hotel in Portsmouth and George’s home in Norfolk.
       The   ticket   price   for  the  event  is  $35.00  with  sponsorship
opportunities  available  as well.  Checks can be made payable to VPTA PAC,
unfortunately  the PAC is not set up to take credit cards at this time. The
event  is limited to 60 guests and responding by October 4th would increase
the chances of ticket availability.
        Please  send  your  check  and,  in  the  memo  line,  indicate  PAC
winetasting.  Please send your check made out to VPTA PAC to:

       Sydney Sawyer, PAC Treasurer
       11907 Henderson Court
       Clifton, VA  20124-5509

       Hope to see you there. If you have already reserved your spot thank
you for your support and I look forward to toasting you at the winetasting!

       With Warm Regards,

       George Maihafer, PT, PhD
       PAC Chair


(Embedded image moved to file: pic21941.jpg)


(See attached file: WINETASTING FLIER.DOC)

I apologize for not including the reimbursement list that Angela
Brooks had mentioned in the earlier e-mail.  Here is the complete
message, with the list at the end of the document.

Debbie Kelly, Executive Director
Local Coverage Determination (LCD)
For Physical Medicine and Rehab Y-18AB

History:
Trailblazer Health is the intermediary for Medicare in the state of
Virginia. LCDs or local coverage determinations are utilization
management guidelines that Trailblazer uses to communicate billing
requirements and coverage standards for various medical procedures.
When a proposal is made to amend LCD language, it is posted to the
Trailblazer website and a period of time is allotted for
provider/member commentary via the website tools.

Current:
It was brought to my attention that Trailblazer has issued a
proposed LCD impacting Physical Medicine and Rehabilitation to
update the 7/5/2005 LCD.  The current LCD (Y-13B-R7) and the
proposed LCD
(Y-18AB) can be found on www.Trailblazerhealth.com. The commentary
period began on 6/29/2005 and will end on 8/15/2005.

Based on the input that I have received, members are unhappy with
the current LCD and are confused and further frustrated by the new
proposed format.

The following list summarizes what appear to be the primary issues
of concern; issues that I urge members to comment to utilizing the
website or postal service (the mailing address is also supplied on
the website). Please note, this is only a summary, other individual
practitioners may note parameters that impact their unique practice
situations. If practitioners note that there are statements not
addressed here that would seemingly affect a number of providers,
please feel free to communicate these via the listserv, as well as
via the Trailblazer website.

Angela S. Brooks, PT
VPTA Payer Relations Specialist



The issues marked * are those that are also included in the original
LCD language and are lingering areas of concern.

1. In the Indications and limitations for Coverage and/or
Medical Necessity, Passive modalities are not defined. Shall
providers defer to the definition in the current PM&R LCD?

2. In the Utilization Guidelines, there are specific services
or procedure numbers (25 and 40) anticipated for various diagnostic
categories. What resources were utilized in developing these
numbers?

3. In the Utilization Guidelines, a maximum of 80 services is
defined per calendar year per member. What options does this leave
for members presenting with more than one diagnosis in a given year?

4. *In the General Modality Guidelines, why is mechanical
traction limited to 25% of the treatment in a given day, whereas
other passive modalities are not limited in this way but rather 25%
for a given treatment course.

5. *In the General PM&R Guidelines treatment time is limited to
30-45 minutes, otherwise additional documentation is required. What
information is this based upon as this does not define the standard
clinical treatment duration?

6. *Iontophoresis is not covered per the General Modality
Guidelines. This is an effective therapeutic procedure. What
information is required to have the reconsidered?

7. In the General PM&R Guidelines does the ordering physician
need to acknowledge his/her awareness of and agreement with the
treatment plan in writing on the 30th day after the initial therapy
evaluation or on or before the 60th day and every thirty days
thereafter? There is contradiction between the verbiage in the LCD Y-
13-BR7 and the proposed LCD Y- 18AB.

Greetings: Angela Brooks, the VPTA's Payer Relations Specialist,
requested that I send you the following time-sensitive announcement.
Thanks very much.
Debbie Kelly, Executive Director

Local Coverage Determination (LCD)
For Physical Medicine and Rehab Y-18AB

History:
Trailblazer Health is the intermediary for Medicare in the state of
Virginia. LCDs or local coverage determinations are utilization
management guidelines that Trailblazer uses to communicate billing
requirements and coverage standards for various medical procedures.
When a proposal is made to amend LCD language, it is posted to the
Trailblazer website and a period of time is allotted for
provider/member commentary via the website tools.

Current:
It was brought to my attention that Trailblazer has issued a
proposed LCD impacting Physical Medicine and Rehabilitation to
update the 7/5/2005 LCD.  The current LCD (Y-13B-R7) and the
proposed LCD
(Y-18AB) can be found on www.Trailblazerhealth.com. The commentary
period began on 6/29/2005 and will end on 8/15/2005.

Based on the input that I have received, members are unhappy with
the current LCD and are confused and further frustrated by the new
proposed format.

The following list summarizes what appear to be the primary issues
of concern; issues that I urge members to comment to utilizing the
website or postal service (the mailing address is also supplied on
the website). Please note, this is only a summary, other individual
practitioners may note parameters that impact their unique practice
situations. If practitioners note that there are statements not
addressed here that would seemingly affect a number of providers,
please feel free to communicate these via the listserv, as well as
via the Trailblazer website.

Angela S. Brooks, PT
VPTA Payer Relations Specialist