Our 2022 advocacy campaign focuses on improving patient access to pulmonary rehabilitation programs and to the expertise of respiratory therapists. As noted on our website, we are asking Congress to co-sponsor the Improving Access to Quality Cardiac Rehabilitation Act (H.R. 1956/S. 1986), and to make permanent temporary waivers implemented during the public health emergency (PHE) that allow cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) services typically delivered in the hospital outpatient setting to be furnished virtually in a patient’s home and to include respiratory therapists as telehealth practitioners for services delivered in the physician office setting.
Improving Access to Quality Cardiac Rehabilitation Act (H.R. 1956/S. 1986)
Why is it important to support this bill and how will it help patients?
When the cardiac and pulmonary rehabilitation programs were first implemented in 2010, the statutory language defined them as “physician-supervised” programs. The Centers for Medicare & Medicaid Services (CMS) made it clear that the language was very specific and, therefore, unlike other outpatient therapeutic programs that allowed direct supervision to be provided by qualified nonphysician practitioners, only physicians could provide direct supervision of CR and PR services.
Over the years, this restriction has led to barriers to access, especially in Critical Access Hospitals where due to the location in rural or underserved areas, physician shortages are more prevalent. Legislation enacted in 2018 would allow physician assistants, nurse practitioners and critical nurse practitioners to provide direct supervision of CR and PR programs, but not until Jan. 1, 2024. The “Improving Access to Quality Cardiac Rehabilitation Act” moves up the effective date to Jan. 1, 2022, and expands their services to administer programs, prepare and sign treatment plans, and prescribe exercise in addition to providing direct supervision.
Making Permanent Temporary Waivers Granted During the Public Health Emergency
You refer to Hospital Without Walls in information on the AARC Advocacy webpage. What does that mean?
Telehealth services under current law cannot be furnished in a patient’s home. The COVID-19 PHE provided CMS with waiver authority through the CARES Act to provide temporary, flexible options to ensure the safety of vulnerable Medicare beneficiaries who were reluctant to receive services in the outpatient hospital setting or their physician’s office. Those flexibilities end at the conclusion of the PHE.
What temporary services can respiratory therapists provide virtually in the patient’s home?
Respiratory therapists (RT) can furnish services provided in the physician office that are included on CMS’ telehealth services list as part of the Medicare Part B “incident to” benefit where an eligible practitioner bills for the services provided by the RT. As noted above, RTs cannot bill Medicare independently for their services. Pulmonary rehabilitation services are on the physician office telehealth list and can be furnished only through December 31, 2022. Other services that are applicable until the end of the PHE include certain ventilatory management services and demonstration/evaluation of inhaler techniques. In the hospital outpatient setting, RTs can furnish virtual pulmonary rehabilitation services to a patient in their home if the hospital has identified it as a temporary provide-based department of the hospital under the HWW program.
Is there legislation already drafted that will make these virtual waivers permanent?
No. That is why it is critical for AARC and its members to advocate for additional authority from Congress to find a permanent solution so Medicare beneficiaries, and especially those with chronic and acute respiratory conditions, do not lose the care they receive now that can improve their health outcomes.
What will happen if Congress doesn’t act to grant permanent authority for these services?
If Congress does nothing to make permanent the temporary waivers that impact RTs and their patients, RTs will no longer be able to furnish any services virtually. Under current law, RTs are not listed among the practitioners that are qualified to furnish telehealth services, even though the “incident to” provision which allows them to provide services during the PHE is a permanent Medicare benefit category. The law would have to be changed to allow them to continue under that authority. The Hospital Without Walls program would cease. Patients in pulmonary rehab programs would not be able to receive services in their homes by RTs and would have to revert to traveling to the program’s hospital outpatient setting. The same is true for physicians’ offices. This scenario sets up a barrier to access, especially for those who live in rural and underserved areas and must travel long distances to receive their care.
When does the public health emergency end?
Other Bills We Have Supported
Why didn’t we promote the CONNECT for Health Act like we did last year, since it’s about RTs and telehealth?
To recap, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (H.R. 2903/S. 1512) would increase access to telehealth services by health care professionals, such as respiratory therapists (RTs), who are not currently described as eligible practitioners in the Medicare program’s telehealth benefit, as part of new payment models being tested by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.
During this session of Congress there were several bills regarding telehealth that included the CONNECT for Health Act. As part of the 2022 Omnibus Reconciliation Bill, Congress passed a temporary extension of telehealth services at the conclusion of the PHE to allow more time to develop permanent solutions. That action takes precedence over any other telehealth bills being considered. If the CONNECT Act becomes a viable bill in the future, we will continue to advocate for its passage.
What is the status of the Allied Health Workforce Diversity Act? Do we need to get more cosponsors?
The Allied Health Workforce Diversity (AHWD) Act (H.R. 3320/S. 1679) authorizes assistance for increasing workforce diversity in the allied health professions, including respiratory care. It will provide grants and scholarships to eligible entities, including students from racial and ethnic minorities, to increase educational opportunities that could lead to an associate’s, bachelor’s, master’s, or doctoral degree or even assistance to complete prerequisite courses or other preparation necessary to be accepted for enrollment in one of allied health programs. It can help to help with retention of new students coming into respiratory therapist programs to meet future healthcare needs for those with chronic and acute respiratory problems.