AARC Legislative Agenda Frequently Asked Questions

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.

Moving up the effective date provides programs that are struggling due to lack of the ability to provide direct physician supervision to have the help they need from other qualified practitioners so they can continue providing important treatment options for those with COPD and now COVID-19. As of Jan. 1, 2022, CMS expanded coverage of PR programs to include beneficiaries who had suspected or confirmed COVID-19 and continued to experience respiratory dysfunction for 4 weeks. Hospitalization was not a requirement for coverage, which opened the door for more patients with respiratory distress to receive the expertise of respiratory therapists who are a vital part of the multi-disciplinary team providing patient care.

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.

To meet the waiver requirements, hospitals must seek permission from CMS to consider a hospital outpatient’s home as a temporary provider-based department of the hospital to receive payment for services furnished in the patient’s home. CMS calls this program “Hospital Without Walls (HWW).” Additionally, because hospitals do not bill for Medicare telehealth services, if they employed certain practitioners who are not authorized to independently bill Medicare for their services, such as respiratory therapists who are part of a multi-disciplinary pulmonary rehab team, the hospital may bill for the outpatient hospital services provided by that staff using telecommunications technology. Telecommunications technology is defined as real-time, two-way audio/visual telecommunications. It’s technically “telehealth,” but due to differences in payment methods, under the HWW program CMS cannot use that term for services furnished in the hospital outpatient setting.

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?

The COVID-19 public health emergency (PHE) currently expires on April 16, but the administration is expected to renew it for an additional 90 days. The administration has stated that they will attempt to give at least 60 days’ notice before ending the PHE.

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.

We have made considerable progress at the federal level since the bills were introduced working with our partners in the allied health professions that include physical therapists, occupational therapists, speech-language pathologists, and audiologists. On the House side, the bill has made it through committee hearings and markup, and the next action in the House is for a formal floor vote. On the Senate side, a provision of the AHWD Act has recently been included in a new bill called the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act), S.3799. The bill will now head to the full Senate floor for consideration later this year. We are working with our Allied Health Coalition members to determine the next course of action and whether we need to launch a grassroots effort to secure passage. We will keep members informed and will generate additional advocacy efforts at the appropriate time, as needed.