AAPM&R is Calling for a Comprehensive National Plan to Address the Needs of Millions Suffering from Long COVID

According to two recent publications from the Journal of the American Medical Association, ten to thirty percent of individuals who had COVID-19 reported at least one persistent symptom up to six months after the virus left their bodies. That means 3 to 10 million Americans are experiencing symptoms of Long COVID or Post-Acute Sequelae of SARS-CoV-2 infection (PASC), which are varied and ongoing, including neurological challenges, cognitive problems such as brain fog, shortness of breath, fatigue, pain, and mobility issues.

AAPM&R called on President Joe Biden and Congress to gear up for the next coronavirus crisis by preparing and implementing a comprehensive national plan focused on meeting the needs of millions of individuals suffering from the long-term symptoms of COVID-19, and help them regain quality of life and return to being active members of their communities. The plan must include a commitment to three major components:

  • Resources to build necessary infrastructure to meet this crisis
  • Equitable access to care for patients
  • Research to advance medical understanding of Long COVID

PM&R physicians are uniquely qualified to help guide the multidisciplinary effort needed to develop a plan for this crisis. As a specialty, physiatrists are investigators, team leaders and problem solvers. PM&R physicians see the whole patient AND the whole picture of the rehabilitation ecosystem. Physiatrists are exactly what this crisis needs. Learn more about our Multidisciplinary PASC Collaborative, launched in March 2021, which is working on quality improvement initiatives.

AAPM&R Advocacy, Healthcare Collaborations and Partnerships, and Customized Resources to Support PM&R During This Crisis

AAPM&R is working to ensure PM&R is part of the national conversation about healthcare amidst COVID-19 and advocating for the federal support, legislation, regulation relief and resources that physiatrists need now. One way we are doing this is through our partnerships and collaborations with other specialty societies. The Academy continuously works to represent PM&R through these collaborations, and it is through these partnerships that we are able to discuss and share a variety of resources with you that you critically need.

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COVID-19 Waivers Update – Select SNF Waivers Expiring May 7

May 05, 2022

Last month, the Centers for Medicare & Medicaid Services (CMS) announced its intention to end certain blanket waivers associated with the COVID-19 emergency declaration.  Specifically, several waivers impacting skilled nursing facilities will end on May 7 and an additional series of waivers will end June 5.  CMS notes that it is concerned that continuing to waive certain requirements may negatively impact resident care.  They have therefore chosen to terminate these waivers in advance of the termination of the public health emergency.  Seven waivers expire on May 7, including three waivers that may most significantly impact PM&R.  These waivers expanded the physician’s ability to delegate in the SNF setting and allowed flexibility regarding use of telehealth.

Physician Delegation of Tasks in SNFs - 42 CFR §483.30(e)(4)
CMS waived the requirement that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally. This waiver gave physicians the ability to delegate any tasks to a physician assistant, nurse practitioner, or clinical nurse specialist, but specified that any task delegated under this waiver must continue to be under the supervision of the physician.

Physician Visits - 42 CFR §483.30(c)(3)
CMS waived the requirement that all required physician visits (not already exempted in §483.30(c)(4) and (f)) must be made by the physician personally. The waiver modified this provision to permit physicians to delegate any required physician visit to a nurse practitioner, physician assistant, or clinical nurse specialist who is not an employee of the facility, who is working in collaboration with a physician, and who is licensed by the State and performing within the state’s scope-of-practice laws.

Physician Visits in Skilled Nursing Facilities/Nursing Facilities - 42 CFR §483.30
CMS waived the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options.

CMS has chosen to keep many additional waivers in place.  Three significant waivers that impact PM&R, relate to increased flexibilities around the 3-day rule in the SNF and the 60 percent and 3-hour rules in the IRF.  Per the CMS website:

3-Day Prior Hospitalization Rule
CMS has waived the requirement for a 3-day prior hospitalization for coverage of a SNF stay for those who experience dislocations or are otherwise affected by COVID-19.

60 Percent Rule
CMS allows that patients admitted to the IRF solely to respond to the emergency (as documented in the patient record) will not count towards calculation of thresholds associated with the 60 percent rule.

3-Hour Rule
CMS has waived that payment be contingent upon patients of an inpatient rehabilitation facility receiving at least 15 hours of therapy per week.

These waivers are anticipated to remain in place through the duration of the public health emergency, which is set to end on July 15 if it is not extended further.  AAPM&R continues to monitor messaging from CMS and the Department of Health and Human Services regarding policy changes tied to the public health emergency.  Members with specific waiver questions can contact the Academy at healthpolicy@aapmr.org.