On March 18, AAPM&R sent a letter to the Centers for Medicare & Medicaid Services (CMS) seeking additional waivers on regulations in response to COVID-19 relevant to the IRF, SNF, and PAC settings as well as guidance pertaining to outpatient care including telemedicine provisions.

Specifically, we requested “that CMS also waive important coverage guidelines such as the three-hour rule, otherwise known as the intensity of therapy requirement. In the foreseeable future, we expect many patients to require close physician supervision but not necessarily an intensive therapy program. We do not believe the intensity of therapy requirement should stand in the way of COVID-19 patients receiving needed hospital care.”

In response to our letter, the Coronavirus Aid, Relief, and Economic Security (CARES) Act includes a provision waiving the 3-hour rule, which AAPM&R has been advocating for all week. This bill was passed by the Senate on March 25, passed by the House on March 27, and was officially signed into law on March 27.

AAPM&R also joined in collaboration with the American Medical Association, American Academy of Family Physicians, American College of Physicians, and other organized medicine groups on a letter urging Congress to include in the final “stimulus” legislation, specific provisions to help physicians sustain their practices and provide their patients with the best possible care during the COVID-19 emergency.

The letter asked for dedicated and direct financial support to physicians and their practices on the front lines of testing, diagnosing, and treating patients at risk of COVID-19, recognizing the increased costs they are incurring in the care of such patients as well as financial support to all physicians and practices who are experiencing adverse economic impact on their practices from suspending elective visits and procedures. We also strongly urged Congress to take all possible actions to ensure that every physician, and every health care worker, has access to critically-needed PPE.

Some of these issues are addressed in the CARES Act with the following provisions:

• Creates a new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
• $100 billion in direct financial support to hospitals, physician practices, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.

The bill includes other provisions of interest to physicians and their practices including:

• Suspension of the 2% Medicare sequester in May through December 2020.
• Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
• Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
• Secretary will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.

AAPM&R advocates for YOU so that you can focus on your practice and patients during this COVID-19 crisis. We are continuing to add resources in our COVID-19 Physiatrist Member Support and Resource Center. Please email us at covidresponse@aapmr.org if you would like to submit additional resources that may be helpful to your peers.