COVID-19

COVID-19

Just a little FYI..

LOTA typically reserves assistance for research into special topics for members only, as a perk of membership.
However, considering the sensitivity and nature of the COVID-19 pandemic, LOTA is sharing all available information with all OTs in the state.
If you are not a current member, please join now. We have strength in numbers and need your support!

Refer to LOTA updates and resources/links provided below for more information.

PROVIDING CARE IN COVID-19 PANDEMIC: March 24

WEEKLY LEGISLATIVE UPDATES: June 5, May 29, May 22, May 15, May 8, May 1, April 23, April 17, April 10, April 3, March 27, March 20

TELEHEALTH UPDATES: April 30, April 9, March 31, March 30, March 26, March 24, March 23, March 19

-OTs FINALLY RECOGNIZED BY CMS AS TELEHEALTH PROVIDERS DURING COVID-19: April 30

OUTPATIENT: MAINTENANCE INTERVENTION CAN BE PROVIDED BY ASSISTANTS DURING COVID-19: April 30

HOME HEALTH: TEMPORARY WAIVER ALLOWS OT TO COMPLETE INITIAL & COMPREHENSIVE ASSESSMENTS; ALLOWS OT TO BE STAND ALONE DISCIPLINE: March 14

CALL TO ACTION RE: IDEA: March 23

CLARIFICATION ON "LDH NOTICE RE: MEDICAL AND SURGICAL PROCEDURES 3/18/2020: March 19

ADDITIONAL RESOURCES (Provided to LOTA from AOTA): Resources

June 5, 2020:

WEEKLY LEGISLATIVE UPDATE (FINAL LEGISLATIVE REPORT)

The Louisiana Legislature adjourned Sine Die at 6 pm Monday June 1^st and immediately convened the 2020 First Extraordinary Session, more commonly known as a Special Session. This is only the second time in history that the legislature has called itself into session as the general practice is for the Governor to call the special session. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_8c35094e-9c54-11ea-9e3a-5fecd8f7dd91.html By calling themselves into session, the Republican led legislature gets to set the agenda of the items to be discussed in the Special Session. Here are the 41 items in the call https://legis.la.gov/archive/201es/call.pdf It is very doubtful that all of these items will make it into legislative instruments as many Capitol observers believe the real purpose of the Special Session is to determine if the Governor issues any vetoes and whether the Legislature will want to try and override those vetoes.

The four week Regular Session moved very rapidly and although the legislature did not act on the budget, it did act on several key items that are waiting on the Governor to act. Senate bill 418 was touted as the most important issue for the business community and passed through the adoption of a Conference Committee report in the final minutes of the session. Many believed that the Governor would veto it, however there now appears to be a serious flaw in the drafting of the report which may give the Governor a legitimate reason to veto it. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_4dff96d0-a528-11ea-9539-7fe425ee4f68.html The legislature passed a comprehensive medical marijuana bill by House Health Committee Chairman Larry Bagley https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_f6b940d6-a1f0-11ea-a29b-57ae2defae71.html SB 395 by Senator Cloud passed aimed at curtailing lawyer advertising. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_22c16b28-a411-11ea-9548-872aeffff578.html Several bills passed limiting liability from lawsuits on persons and businesses dealing with Covid 19 response. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_6e81ced0-a1ec-11ea-9123-2ba5442c08f9.html The most drama on the final day of the session was not legislation at all, but rather the secret vote in Executive Session on Senate Confirmations that occurs in the Senate on the Governor’s appointments. Senator Karen Carter Peterson blackballed two of her constituents to high profile positions, Ronnie Jones as Chair of the Gaming Control Board and former House Speaker Pro Tem Walt Leger as Chairman of the New Orleans Convention Center. The reasons are outlined in this very interesting article and the Governor is very upset at the Senator who also chairs the Louisiana Democratic Party for not consulting with him. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_74f9eb10-a4eb-11ea-b3d8-13ee719532d9.html

The budget will be the main item of this Special Session. The Louisiana House last week backed a $30 billion-plus spending plan for next year, HB 105, that used federal coronavirus aid to keep programs and services on an even keel despite the pandemic. The package of budget bills — approved in a quick afternoon of House votes rather than the daylong debate of years past was never brought to the Senate Finance Committee to be heard. Instead, the Legislature is expected to finish the budget in a special session. The House Appropriations Committee began debate on the budget bill, HB 1, Tuesday morning which was filed and is identical to HB 105 that passed the House during the Regular Session. The budget plans are largely in line with Governor John Bel Edwards’ recommendations for spending available federal aid, using the state’s “rainy day” fund and avoiding steep slashing to agencies. HB 1 is scheduled to be reported from the Appropriations Committee later today and likely will be on the House Floor Monday. Following are some of the essentials of the budget:

· Modest cuts would fall on the health department, public college campuses and other departments.

· The TOPS college tuition program, the K-12 school financing formula, the social services agency and prisons would be spared reductions.

· Planned spending increases proposed before the pandemic for teacher pay, colleges and early learning programs have been removed because Louisiana can no longer afford them.

· Legislative agencies would get more money, as would the judicial branch.

The largest point of financial disagreement between the majority-Republican Legislature and the Democratic Governor centers on a $1.8 billion slice of direct federal aid allocated to Louisiana by Congress under the Cares Act. Nearly $1 billion would be used to rebalance this year’s budget and help craft next year’s spending plans. Edwards and GOP lawmakers disagree about how to spend the remaining $811 million. The governor intended to steer that money to local government agencies to help them with their COVID-19 response, though the Edwards administration has acknowledged those agencies likely won’t have enough expenses that meet the federal aid criteria. Republican lawmakers proposed instead $300 million of the money for small business grants — and they’re suggesting a different method for divvying up the remainder to local government than the program the Edwards administration created. That legislation, SB 189, passed and now it will be up to the Governor to sign or veto the legislation.

Louisiana is set to enter into Phase Two beginning today, Friday, June 5^th. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_ee4ff1ac-a424-11ea-8b66-5b6b118f2ab3.html Louisiana continues to see both the health impacts of the virus and the economic downturn caused by COVID 19 as it grapples with the best way to move forward. As of Thursday at Noon, the Department of Health was reporting 41,562 cases, 2,772 persons who have died, and 613 who are currently hospitalized. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html Hospitalizations thankfully continue to decrease.

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

***Legislative updates are usually reserved for members. If you are not a current member, please join LOTA, as we continue to advocate for our profession during these times and ALWAYS! http://lota.camp9.org/join

Update May 29, 2020:

WEEKLY LEGISLATIVE UPDATE

With only 3 days to go before this unprecedented session must conclude, committee meetings are done and legislation that may pass is becoming more clear. After 6:00 pm today, for a bill to be considered on the floor, it will take a 2/3 vote by both chambers to consider it. Today should have marked the conclusion of the twelfth week of the 2020 Regular Session of the Legislature, but in reality, it is really like the end of week four of a very fast four week session. The 2020 Regular Session must conclude Monday, June 1. The legislative process has been very difficult to navigate for legislators and the public alike. Members are spread out and lobbyists and the public are forced to sit every other seat, on every other row in committee rooms with an overflow room always available for those not comfortable despite the seating distance. The public is encouraged to submit written comments via email, and although the comments are made part of the record, they are not read in, leaving many to opine….what’s the point? Legislators, staff, lobbyists and the public have been trying to abide by the protocols which means there is no access to either Chamber, witness cards are collected in the hallway of committees, there is no approaching members at the dais in committee, no handouts are distributed the day of committees, and lobbyists are encouraged to handle most business by phone or email. Obviously, this emergency process limits the public’s input.

The four week session has not allowed much time to hear legislative instruments The key bills that seem to be moving through the process involve tort reform which has been debated for hours in numerous committees. On Thursday, truckers gathered with their truck at the capitol, to voice their support for SB 418 that will be debated on the House floor later today and purports to make sweeping changes to courtroom practices and to reduce insurance rates.  https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_f6ce210a-9f5b-11ea-8792-63c205de1740.html The legislature rarely overrides a Governor’s veto, but with anticipation that the Governor may veto SB 418, a vote on legislative override of a veto could be coming soon. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_b1d50652-9cfb-11ea-8837-0b18cb36c8ee.html

The Louisiana House on Tuesday backed a $30 billion-plus spending plan for next year that uses federal coronavirus aid to keep programs and services on an even keel despite the pandemic. The package of budget bills — approved in a quick afternoon of House votes rather than the daylong debate of years past — is now in the Senate for debate. Senators don’t expect to complete their work before that deadline. Instead, the Legislature is expected to finish the budget in a special session that starts immediately after the regular session ends Monday. Lawmakers voted unanimously for the operating budget for the 2020-21 financial year that begins July 1, along with separate measures to allocate dollars to legislative and judicial agencies. In addition, the House agreed to a proposal that would rebalance this year’s budget and close gaps that emerged because of the virus outbreak. The plans are largely in line with Gov. John Bel Edwards’ recommendations for spending available federal aid, using the state’s “rainy day” fund and avoiding steep slashing to agencies. Following are some of the essentials:
·      Modest cuts would fall on the health department, public college campuses and other departments.
·      The TOPS college tuition program, the K-12 school financing formula, the social services agency and prisons would be spared reductions.
·      Planned spending increases proposed before the pandemic for teacher pay, colleges and early learning programs have been removed because Louisiana can no longer afford them.
·      Legislative agencies would get more money, as would the judicial branch.
The largest point of financial disagreement between the majority-Republican Legislature and the Democratic governor centers on a $1.8 billion slice of direct federal aid allocated to Louisiana by Congress under the Cares Act. Nearly $1 billion would be used to rebalance this year’s budget and help craft next year’s spending plans. But Edwards and GOP lawmakers disagree about how to spend the remaining $811 million. The governor intended to steer that money to local government agencies to help them with their COVID-19 response, though the Edwards administration has acknowledged those agencies likely won’t have enough expenses that meet the federal aid criteria. Republican lawmakers are proposing instead $300 million of the money for small business grants — and they’re suggesting a different method for divvying up the remainder to local government than the program the Edwards administration created.
Additionally, the budget bills would use nearly $1.2 billion in federal assistance approved by Congress to respond to the pandemic: $991 million from the direct federal payment and $190 million in increased federal Medicaid financing. The state also would tap the Rainy Day Fund for $90 million, using about $45 million less than the full amount available.

The Senate and House will be in all day today and likely will both be working over the weekend in order to conclude this Regular Session Monday.

In a rare move, the Louisiana Legislature will call themselves back into a Special Session set to begin at 6:01 pm on June 1 and to conclude June 30, however, many at the Capitol believe they will finish sooner. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_31c7f9e0-9d16-11ea-b7cd-0f97357383ab.html By calling themselves into session, the legislature sets the agenda. You may review the 41 items in the Call for the 2020 First Extraordinary Session here https://legis.la.gov/archive/201es/call.pdf . Obviously, passing a budget by June 30^th prior to the new fiscal year July 1 will be critical, and the House plans to use the budget that passed the House and referenced above as its starting point.

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

Update May 22, 2020:

WEEKLY LEGISLATIVE UPDATE

With only 10 days to go before this unprecedented session must conclude, committee meetings are beginning to wind down and legislation that may pass is becoming more clear. Today should have marked the conclusion of the eleventh week of the 2020 Regular Session of the Legislature, but in reality, it is really like the end of week three of a very fast four week session. The 2020 Regular Session must conclude June 1. The legislative process has been very difficult to navigate for legislators and the public alike. Members are spread out and lobbyists and the public are forced to sit every other seat, on every other row in committee rooms with an overflow room always available for those not comfortable despite the seating distance. The public is encouraged to submit written comments via email, and although the comments are made part of the record, they are not read in, leaving many to opine….what’s the point? Legislators, staff, lobbyists and the public have been trying to abide by the protocols which means there is no access to either Chamber, witness cards are collected in the hallway of committees, there is no approaching members at the dais in committee, no handouts are distributed the day of committees, and lobbyists are encouraged to handle most business by phone or email. Obviously, this emergency process limits the public’s input. Although many legislators are practicing social distancing and wearing masks in the Capitol, as I helped host an outdoor event Wednesday night at the Speaker’s apartment for all the House members, I could not help but notice there was not a mask to be seen!

The Legislature has a little over one week to conclude its business before it must constitutionally adjourn. The four week session has not allowed much time to hear legislative instruments, but this week saw a number of measures be heard as committee work starts to end. The key bills that seem to be moving through the process involve tort reform https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_72e0c97e-9943-11ea-9f8e-23b2ceba136f.html and ending coastal lawsuits. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_6cd3d468-9af6-11ea-bb8a-9789347b6b71.html . Additionally, the Governor and the Legislature continue to fight over the spending of surplus dollars from the fiscal year that ended June 30, 2019. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_92f506c2-9942-11ea-95ea-b7b83e5dee64.html. Every year it seems the legislature continues to loosen medical marijuana laws and this year is no exception. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_247881fc-9ad1-11ea-9c45-478cb01a3c63.html

The House of Representatives is scheduled to debate the budget and other money bills on the House floor Tuesday after the budget bills moved out of the House Appropriations Committee Thursday. The House committee followed the recommendation of the Governor to use one time federal aid through the Cares Act and some Rainy Day dollars to plug the holes and avoid massive cuts to healthcare and higher education. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_948505ee-9b7e-11ea-808d-4fcdfa2e5414.html The Senate will receive the budget next week with only days remaining in the session, therefore it may very well be that time runs out on the budget as the Senate will likely be prudent and not rush to get a budget done. It is very likely that for the first time in recent times, the Legislature and not the Governor will call a Special Session and dictate the items in the call, which is rumored to begin June 8^th. If that occurs, it will give them three weeks to resolve the budget bill before the new fiscal year begins July 1. Despite the budget issues the House has passed numerous tax breaks for business drawing the Governor’s disapproval. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_4546a138-9951-11ea-948b-8b10d1e08dd5.html The House Appropriations Committee also took a conservative stand on spending surplus dollars disagreeing with the Governor’s belief it should be spent on infrastructure. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_92f506c2-9942-11ea-95ea-b7b83e5dee64.html. The Senate will come in today for short session and then break for some committee meetings and then take a long weekend. The House will come in today at 9:00 am and has a very long list of House bills on Final Passage to handle, if they don’t conclude today, it could mean more floor work Saturday or Monday.

In news outside of the Capitol, the Louisiana Board of Elementary and Secondary Education after a lengthy search for a State Superintendent to replace John White, voted Wednesday to select his predecessor, Dr. Cade Brumley, the current Superintendent of the Jefferson Parish School System. https://www.theadvocate.com/baton_rouge/news/education/article_4de1d458-9a18-11ea-9e60-f39892b28d68.html

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

Update May 15, 2020:

WEEKLY LEGISLATIVE UPDATE

Today should have marked the conclusion of the tenth week of the 2020 Regular Session of the Legislature, but in reality, it is really like the end of week two of a very fast four week session with only two weeks remaining until the sine die date June 1st. The committee meetings have been very difficult to navigate for legislators and the public alike. Members are spread out and lobbyists and the public are forced to sit every other seat, on every other row in committee rooms with an overflow room always available for those not comfortable despite the seating distance. The public is encouraged to submit written comments via email, and although the comments are made part of the record, they are not read in, leaving many to opine….what’s the point? Legislators, staff, lobbyists and the public have been trying to abide by the protocols which means there is no access to either Chamber, witness cards are collected in the hallway of committees, there is no approaching members at the dais in committee, no handouts are distributed the day of committees, and lobbyists are encouraged to handle most business by phone or email. Obviously this emergency process limits the public’s input. Many legislator’s have tried to kill legislation by arguing that the bill is not needed, is not an emergency, nor Covid related but for all practical purposes, once a bill is on the committee agenda, that argument is irrelevant.

The Louisiana Legislature, especially many House Republicans have been trying to overturn the Governor’s Stay at Home Order. However, on Monday the Governor announced that he would be lifting the Stay at Home Order Friday, May 15^th. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_ff5be800-939b-11ea-a93e-4b25026b037b.html The Governor’s Lifting of the Stay at Home Order was released Thursday night and is attached https://gov.louisiana.gov/assets/Proclamations/2020/58-JBE-2020.pdf . The legislature has a little over two weeks to handle its business before it must constitutionally adjourn. The four week session does not allow much time to hear many legislative instruments, but this week saw a number of measures be heard including both the House and Senate versions of tort reform. Wednesday was “tort reform” day at the Capitol as the House Civil Law Committee and the Senate Judiciary A Committee both heard hours of testimony on the Omnibus Premium Reduction Act of 2020 which was filed in both chambers and considered the number one issue of the business community. https://www.theadvocate.com/baton_rouge/news/politics/legislature/article_b7828ad4-94a4-11ea-a35e-877d3bcad05e.html Both measures advanced to the floor of the respective chambers. Today, Friday, the House will have a full day on the floor coming in at 9:00 am and working all day and probably into the night to complete the bills listed on Final Passage, while the Senate will have a short day on the floor so that some committees can meet later today. The Senate will take up two of the most controversial bills of the session on Monday, SB 418, the Omnibus Premium Reduction Act of 2020 which is the major tort reform bill being pushed by business, and SB 359, a bill pushed by the oil and gas associations, landowners and business to end the parish coastal lawsuits against the oil companies. Both will be a classic showdown of trial lawyers vs. business and will be interesting to watch!

The House Appropriations Committee is scheduled to continue debating the budget but in speaking with both House and Senate leadership this week, it appears neither side will rush the budget and we very well will be in a Special Session in June on the budget which must be passed before the start of the new fiscal year July 1. In order to move forward with a budget, the Revenue Estimating Conference (REC) had to meet and adopt an estimated budget forecast and that meeting occurred at Noon Monday, May 11^th and the numbers were staggering. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_c5911aa0-939b-11ea-8c97-73bb30a4e054.html In addition to REC on Monday, the House Appropriations Committee heard public testimony on the budget, and because of the current circumstance, many of the public who would normally be at the committee, was not there. It may very well be that time runs out on the budget and the Senate will likely be prudent and not rush to get a budget done causing them to be in a special session in June trying to resolve the budget bill before the new fiscal year begins July 1.

Louisiana continues to see both the health impacts of the virus and the economic downturn caused by COVID 19 as it grapples with the best way to move forward. As of Thursday at Noon, the Department of Health was reporting 33,489 cases, 2,351 persons who have died, and 1,193 who are currently hospitalized. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html Although deaths continue to increase, the number of hospitalizations has continued to decrease which means hopefully we have hit our peak. All eyes will be on the Governor Monday as he is expected to make an announcement regarding the future re-opening of the state.

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

Update May 8, 2020:

WEEKLY LEGISLATIVE UPDATE

Today should have marked the conclusion of the ninth week of the 2020 Regular Session of the Legislature, but in reality, it is really like the end of week one of a fast and furious four week session. Lawmakers gaveled into session in both the House and Senate chambers on Monday practicing social distancing and referring bills to committee and then adjourning until Thursday night so committees could meet. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_3f3170d4-8e1b-11ea-8ea9-fbbffccf9893.html The committee meetings have been very difficult to navigate for legislators and the public alike. Members are spread out and lobbyists and the public are forced to sit every other seat, on every other row in committee rooms with an overflow room always available for those not comfortable despite the seating distance. The public is encouraged to submit written comments via email, and although the comments are made part of the record, they are not read in, leaving many to opine….what’s the point? Legislators, staff, lobbyists and the public have been trying to abide by the protocols which means there is no access to either Chamber, witness cards are collected in the hallway of committees, there is no approaching members at the dais in committee, no handouts are distributed the day of committees, and lobbyists are encouraged to handle most business by phone or email. Obviously this emergency process limits the public’s input.
The committees have started as early as 8:00 am and adjourned as late 10:00 pm leaving legislators, staff and lobbyists a little grumpy! There has been more than one discussion in the halls of the Capitol, that we are one more legislator sick ness away form shutting this down and the Governor has called it a mistake, that many legislators are not wearing masks. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_0d09010c-8fe8-11ea-988d-a3ffb22d8926.html

The Louisiana Legislature’s return on Monday brought more speculation that the Republican controlled House would try and overturn the Governor’s Stay at Home Order. The Governor’s Stay at Home Order is attached here https://gov.louisiana.gov/assets/Proclamations/2020/52-JBE-2020-Stay-at-Home-Order.pdf. Republican Caucus Chair Blake Miguez filed a Resolution Monday to overturn the Stay at Home Order and the House and Government Affairs Committee spent five hours Wednesday debating the resolution before advancing it to the House floor. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_8591ea82-8faf-11ea-a81f-83ce146d72e5.html The Governor said last week about that effort that “Silly is not the right word”. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_015cfc00-8b24-11ea-b407-bf764ef59ea9.html The legislature has about three weeks to handle its business before it must constitutionally adjourn sine die on June 1. The four week session does not allow much time to hear many legislative instruments, so based on my discussions this week with legislators, I believe they will continue to focus on passing a budget, the state agency sunsets, COVID 19 emergency legislation that may be needed, and try to pass some form of tort reform. The committee chairmen have pruned the committee agendas to only those bills members consider important. The House Appropriations Committee is scheduled to hear from Higher Education and the Department of Health later this morning which are the two groups that budget cuts generally hit because of our constitution. http://legis.la.gov/Legis/Agenda.aspx?m=20216 In order to move forward with a budget, the Revenue Estimating Conference (REC) will meet and vote on an estimated budget forecast and that meeting will take place Monday, May 11^th http://legis.la.gov/Legis/Agenda.aspx?m=20209 The REC will be reviewing the current year’s budget and determining if the impact of the epidemic and the low oil prices requires any downward shifts necessary in revenue, and they will also be looking at the forecast for next fiscal year which some estimate Louisiana could be short as much as $500 million. In other bad news, it was reported Thursday that Louisiana’s tax collections have plummeted by $500 million from last year at this time. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_86849d52-9083-11ea-b86d-5ff99a123a8a.html In addition to REC on Monday, the House Appropriations Committee is scheduled to hear public testimony on the budget, which because of the current circumstance, can be emailed in if the public would rather not appear in person. It may very well be that time runs out on the budget and the Senate will likely be prudent and not rush to get a budget done causing them to be in a special session in June trying to resolve the budget bill before the new fiscal year begins July 1. There likely will be a need for at least one special session and possibly a second one in the fall as the impacts of the coronavirus crisis on the state budget and Louisiana’s economy are determined and adjustments have to be made.

Louisiana continues to see both the health impacts of the virus and the economic downturn caused by COVID 19 as it grapples with the best way to move forward. As of Thursday at Noon, the Department of Health was reporting 30,652 cases, 2,135 persons who have died, and 1,432 who are currently hospitalized. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html Although deaths continue to increase, the number of hospitalizations has continued to decrease which means hopefully we have hit our peak. All eyes will be on the Governor Monday as he is expected to make an announcement regarding the future re-opening of the state.

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

Update May 1st, 2020:

WEEKLY LEGISLATIVE UPDATE

Today should have marked the conclusion of week seven of the 2020 Regular Session of the Legislature, but instead the Legislature remains adjourned pending notice of the House Speaker and the Senate President. Senate President Page Cortez announced this week that he had recovered from Covid 19 https://www.theadvocate.com/baton_rouge/news/coronavirus/article_6ecb19ba-8585-11ea-b6da-6358f6303e7f.html Two legislative committees did meet Wednesday at the Capitol, the Senate and Governmental Affairs Committee and the House and Governmental Affairs Committee held separate meetings to re-consider an emergency election plan proposed by Republican Secretary of State Kyle Ardoin that was voted down last week by the same committees. The major contention last week by the Republican Senators was the ease of obtaining a mail in ballot and the concern of mischief and fraud associated with mail in ballots. The Senate committee rejected the emergency plan last week which left the Presidential election and the Fall elections in jeopardy. However, the Secretary of State and the Republican legislators worked throughout the week on revisions to the plan, specifically making it harder to qualify for the mail in ballot, and the new plan breezed through both the Senate and House committees. Ironically, after being approved by both committees the emergency plan now proceeds to a vote of both chambers of the legislature, by Mail-In-Ballot!

Rumors and discussions with legislators this week still point to a return of the Louisiana Legislature possibly on May 4, 2020, but only if the Governor does not extend his Stay at Home Order. A May 4^th start would leave only four weeks before it would have to constitutionally adjourn sine die on June 1^st. If that occurs, it is likely that there will not be allot of time to hear many legislative instruments, so I believe they would focus on passing a standstill budget, the state agency sunsets, and COVID 19 emergency legislation that may be needed. There are no committee meetings currently scheduled. Also, in order to move forward with a budget, the Revenue Estimating Conference will need to meet and vote on an estimated budget forecast so those numbers can be plugged into the budget. Assuming the legislature convenes, what it will actually look like and the impacts of social distancing on committee hearings, lobbying, staff, state agencies, the public and timing all have yet to be determined. Whatever all of that looks like, it will be a different experience for all involved in state government. It is likely that there will be a need for at least one special session during the summer and possibly a second one in the fall as the impacts of the coronavirus crisis on the state budget and Louisiana’s economy are determined and adjustments have to be made.

Louisiana continues to see both the health impacts of the virus and the economic downturn caused by COVID 19 as it grapples with the best way to move forward. As of Thursday at Noon, the Department of Health was reporting 25,739 cases, 1,540 persons who have died, and 1,727 who are currently hospitalized. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html Although deaths continue to increase, the number of hospitalizations has continued to decrease which means hopefully we have hit our peak. The Governor indicated during a press conference this week that he may look at loosening some of the stay at home restrictions such as elective surgeries and dental practice re-openings and the Department of Health has issued that guidance. http://ldh.la.gov/assets/oph/Coronavirus/resources/providers/LDH-MEMO-UPDATE-RESTORE-MED-SURG-Procedures.pdf

There also has been discussion of extending parts of the Stay at Home Order but nothing firm on that as of yet and the Governor has said he will let the citizens know more next week. The Governor did indicate that Louisiana is trending toward the Phase One benchmarks announced by the President last week. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_68dc6afa-84cb-11ea-934c-8bbc03725a51.html Last Thursday, the New Orleans Mayor did extend the New Orleans Stay at Home Order until May 16^th.

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

Update April 30, 2020:

OTs RECOGNIZED AS TELEHEALTH PROVIDERS DURING COVID-19 PANDEMIC

Occupational Therapists WILL be recognized by CMS as telehealth providers for the duration of the COVID-19 pandemic

Healthcare Workforce Augmentation:

To bolster the U.S. healthcare workforce amid the pandemic, CMS continues to remove barriers for hiring and retaining physicians, nurses, and other healthcare professionals to keep staffing levels high at hospitals, health clinics, and other facilities. CMS also is cutting red tape so that health professionals can concentrate on the highest-level work they’re licensed for.

· CMS is allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. This frees up physical and occupational therapists to perform other important services and improve beneficiary access.

Further Expand Telehealth in Medicare:

CMS directed a historic expansion of telehealth services so that doctors and other providers can deliver a wider range of care to Medicare beneficiaries in their homes. Beneficiaries thus don’t have to travel to a healthcare facility and risk exposure to COVID-19.

· For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

You can read today’s Press Release, in its entirety, at: https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

What a great day for OT, and a great way to wrap up OT Month 2020!

Please make sure you and your co-workers are current and active LOTA members. You can activate or renew your membership at: www.lota.org

Update April 23, 2020:

WEEKLY LEGISLATIVE UPDATE

Today should have marked the conclusion of the eighth week of the 2020 Regular Session of the Legislature, but instead the Legislature remains adjourned, however the Speaker and President held a press conference yesterday afternoon and announced that both bodies will return Monday May 4th, the House at 9:00 am and the Senate at 2:00 pm. The handouts from that press conference are attached and provide the weekly schedule and committee meetings for next week along with the protocols for entry into the Capitol. However, Representative Ted James, Chairman of the House Administration of Criminal Justice, and a COVID 19 survivor, has already given notice on social media, that he will not be returning and called the move disrespectful considering one of their colleagues, died from the virus. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_1a31216e-895a-11ea-bca0-b325f908649a.html How many other legislators will follow him has yet to be determined. The House and Senate Democrat Caucuses as well as the Legislative Black Caucus have sent letters to the Senate President and House Speaker objecting to a May 4^th return and instead suggesting a May 15^th return. The other work done this week was on Monday, when the Legislature by mail in ballot voted to approve the emergency election plan proposed by Republican Secretary of State Kyle Ardoin that was voted out of the House and Senate committees last week. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_5d1b0542-895c-11ea-b75e-6bba365dcb80.html

The Louisiana Legislature’s return on Monday would seem to be at odds with the Governor’s announcement Monday that he would be extending his Stay at Home Order until May 15^th . https://gov.louisiana.gov/home-order-extended-may15/ The Official Revised Stay at Home Order is attached here https://gov.louisiana.gov/assets/Proclamations/2020/52-JBE-2020-Stay-at-Home-Order.pdf. However some Republicans are considering trying to overturn that Order. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_de89df60-8a45-11ea-a103-07ca9b2633e5.html The Governor responded Thursday to that that effort by saying “Silly is not the right word”. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_015cfc00-8b24-11ea-b407-bf764ef59ea9.html The Governor did say that he considers the Legislature “essential” but the May 4^th re-start leaves only four weeks before it must constitutionally adjourn sine die on June 1. The four week session does not allow much time to hear many legislative instruments, so based on my discussions this week with legislators, I believe they will focus on passing a standstill budget, the state agency sunsets, COVID 19 emergency legislation that may be needed, and try to pass some form of tort reform. The committee chairmen have pruned the committee agendas to only those bills members consider important. In order to move forward with a budget, the Revenue Estimating Conference will need to meet and vote on an estimated budget forecast and that meeting will likely take place May 11^th. The House will try and hold no more than three committees at one time while the Senate at least the first week will schedule committee meetings all in the same committee room and each for 1.5 hours with 30 minutes scheduled for cleaning between meetings. For example on Tuesday, Agriculture will meet from 8am – 9:30, Environment from 10 – 11:30; Jud C 12-1:30, Jud B from 2-3:30 and Jud A from 4-5:30. Both plans will make for challenges on numerous fronts! Legislators, staff, lobbyists and the public will all have protocols to follow and for lobbyists they include, no access to either Chamber, witness cards will be collected in the hallway of committees, no approaching members at the dais in committee, no handouts will be distributed the day of committees, and lobbyists are encouraged to handle most business by phone or email. I encourage you to become familiar with the calendars and protocols referenced above. Times they are a changing!

Also, it is likely that there will be a need for at least one special session during the summer and possibly a second one in the fall as the impacts of the coronavirus crisis on the state budget and Louisiana’s economy are determined and adjustments have to be made.

Louisiana continues to see both the health impacts of the virus and the economic downturn caused by COVID 19 as it grapples with the best way to move forward. As of Thursday at Noon, the Department of Health was reporting 28,001 cases, 1,862 persons who have died, and 1,601 who are currently hospitalized. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html Although deaths continue to increase, the number of hospitalizations has continued to decrease which means hopefully we have hit our peak. On Wednesday, Governor Edwards traveled to the White House to meet with President Trump to discuss Louisiana’s response to the crisis. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_69ecc572-8a41-11ea-b402-c703f83fec6d.html https://www.theadvocate.com/baton_rouge/news/politics/article_e0ece99e-89ac-11ea-8b53-9f316de9e154.html

Update April 17, 2020:

WEEKLY LEGISLATIVE UPDATE

Today should have marked the conclusion of week six of the 2020 Regular Session of the Legislature, the halfway mark; instead the Legislature remains adjourned pending notice of the House Speaker and the Senate President. Two legislative committees did meet Wednesday at the Capitol, the Senate and Governmental Affairs Committee and the House and Governmental Affairs Committee held separate meetings to consider an emergency election plan proposed by Secretary of State Kyle Ardoin. The Senate Committee was scheduled to last an hour, social distancing in a large committee room, and the committee room was mostly closed to the public with an overflow room across the hall; however, the Republican led committee peppered Republican Ardoin for nearly three hours on the emergency election plan. The major contention by the Republican Senators was the ease of obtaining a mail in ballot and the concern of mischief and fraud associated with mail in ballots. Ultimately, the Senate committee rejected the emergency plan leaving the Presidential election and the Fall elections in jeopardy as the Secretary of State testified that he will only have a few days to come up with an alternative plan. Following the Senate committee, the House and Governmental Affairs Committee convened its meeting in the House Chamber where it could practice social distancing and hear and ask questions to the Secretary of State. Because the Senate Committee had already rejected the emergency plan, and it takes both committees to approve, the House Committee was really a formality and an opportunity to ask questions. The Secretary of State indicated that he would try and work out a compromise with the legislators despite the tight window to draft a new plan. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_4dfccfd6-7f44-11ea-b67e-73d2172ba20b.html

Rumors and discussions with legislators this week still point to a possible return of the Louisiana Legislature on May 18, 2020, which would leave only two weeks before it would have to constitutionally adjourn sine die on June 1^st. If that occurs, it is likely that there will not be alot of time to hear many legislative instruments, so I believe they would focus on passing a standstill budget, the state agency sunsets, and COVID-19 emergency legislation that may be needed. It is likely that there will be a need for at least one special session and possibly more as the impacts of the coronavirus crisis on the state budget are determined and adjustments have to be made.

Louisiana continues to see both the health impacts of the virus and the economic downturn caused by COVID-19 as it grapples with the best way to move forward. Tuesday and Wednesday of this week recorded more deaths in a 48 hour period than any two day span so far. As of Thursday at Noon, the Department of Health was reporting 22,532 cases, 1,156 persons who have died, and 1,914 who are currently hospitalized. The Governor this week announced and signed a proclamation closing all schools for the remainder of the year. The Proclamation can be read here. https://gov.louisiana.gov/assets/Proclamations/2020/47-JBE-2020-State-of-Emergency-Elementary-and-Secondary-Education.pdf The Governor also formed a new commission, the Resilient Louisiana Commission, to look at bringing the economy back at some future date https://gov.louisiana.gov/index.cfm/newsroom/detail/2467 . Lieutenant Governor Billy Nungesser and many other leaders from the tourism industry will join business leaders, banking leaders, and good government groups like CABL and PAR, to look at best practices in opening Louisiana’s economy. The Governor also said during a press conference this week that he may look at loosening some of the stay at home restrictions such as elective surgeries, dental practice re-openings, and possible restaurant re-opening with less seating occupancy and said he would likely give guidance a few days before his Stay at Home Order expires April 30^th. There also has been discussion of extending parts of the Stay at Home Order until May 15^th but nothing firm on that as of yet. On Thursday, the New Orleans Mayor did extend the New Orleans Stay at Home Order until May 16^th.

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

***Legislative updates are usually reserved for members. If you are not a current member, please join LOTA, as we continue to advocate for our profession during these times and ALWAYS!

http://lota.camp9.org/join/

Update April 14, 2020:

CMS TEMPORARY WAIVER ALLOWS OT TO COMPLETE OASIS AND BE A STAND ALONE DISCIPLINE IN THE HOME HEALTH SETTING

On April 9^th, 2020, CMS temporarily suspended the rule that would prevent OTs from opening Medicare home health cases, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. Occupational therapists may now perform initial and comprehensive assessments for all home health patients receiving therapy as part of the plan of care. According to the CMS Fact Sheet, the waiver:

Allow[s] occupational therapists (OTs) to perform initial and comprehensive assessment for all patients. 42 C.F.R. 484.55(a)(2) and 484.55(b)(3). CMS is waiving the requirement that OTs may only perform the initial and comprehensive assessment if occupational therapy is the service that establishes eligibility for the patient to be receiving home health care. This temporary blanket modification allows OTs to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether occupational therapy is the service that establishes eligibility. The existing regulations at § 484.55(a) and (b)(2) would continue to apply that OTs and other therapists would not be permitted to perform assessments in nursing only cases. We would continue to expect HHAs to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible. Therapists must act within their state scope of practice laws when performing initial and comprehensive assessments, and access a registered nurse or other professional to complete sections of the assessment that are beyond their scope of practice. Expanding the category of therapists who may perform initial and comprehensive assessments to include OTs provides HHAs with additional flexibility that may decrease patient wait times for the initiation of home health services.

**Previously existing limitations were at the Federal level. No State mandate limits OT from functioning in the above capacity. Best Practice Consideration: OT, please ensure adequate training in completion of the OASIS prior to implementation into your practice.

**This waiver is temporary. However, the Medicare Home Health Flexibility Act (H.R. 3127/S. 1725) would make this permanent. Our OT community should to advocate for legislators to co-sponsor/support this bill (if you haven't already) via AOTA's provided resource and via the NAHC (National Association for Homecare and Hospice).

Update April 10, 2020:

WEEKLY LEGISLATIVE UPDATE

The Regular Session of the Legislature began Monday, March 9^th which coincidentally was the date Louisiana received its first positive case of COVID 19, so today should have been a wrap on the fifth week of the Regular Session and an approach to the half way mark of the session. Instead, today legislators mourn the death of one of their own, Representative Reggie Bagala, who had been on a ventilator in a hospital due to COVID 19 died Thursday at the age of 54. https://www.nola.com/news/coronavirus/article_1b719610-7ab6-11ea-9ec8-0f29eb03c71b.html

The Legislature remains shuttered, adjourned upon notice of House and Senate leadership, as bills remain pending in the respective committees with no certainty if and when any of them will be heard. Earlier this week, House Chairmen were told that the legislature may return May 4^th and for the respective chairs to determine what bills would be priority for their committees. Committee meeting were noticed for May 4^th, however by mid-week, those meetings had been cancelled amid rumors that the Governor would likely extend his “Stay at Home” Order until May 15^th, and if that occurs, the legislature likely would come in Monday May 18^th, leaving only two weeks before the constitutionally mandated adjournment on June 1. In that two weeks, it becomes likely that the only bills that would move are the key budget bills that must pass prior to the end of the fiscal year on June 30^th. The current budget is based on oil prices at $59/barrel, casino revenues that are zero right now, and sales tax revenue that is tremendously diminished, so no matter the scenario, it becomes obvious that the Louisiana Legislature will need to be in a Special Session in the Fall to address the uncertainties in the budget and any COVID 19 relief legislation that may be needed.

Last Friday, the Governor extended the “Stay at Home” Order until April 30^th. You can read the Order here. https://gov.louisiana.gov/assets/Proclamations/2020/JBE-33-2020.pdf. As of Thursday, Louisiana had 18,283 cases, 702 deaths and 2,014 individuals in the hospital. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html The good news this week is that Governor Edwards and his top health officials are no longer forecasting that the state will run out of ventilators and hospital beds. The factors cited for this change are social distancing, the fact that there have been fewer hospitalizations, and healthcare providers are doing a great job in either keeping patients off ventilators or getting them off the ventilators sooner. On Thursday, the Board of Elementary and Secondary Education requested Governor Edwards to close Louisiana public schools for the remainder of the 2019-2020 school year, and the Governor has indicated that there is a good chance he will do that and do it relatively soon. The Louisiana High School Athletic Association this week cancelled all spring high school sport seasons for the remainder of the year. Things are changing daily, so I will endeavor to do my best to keep you posted throughout the week.

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

***Legislative updates are usually reserved for members. If you are not a current member, please join LOTA, as we continue to advocate for our profession during these times and ALWAYS!

http://lota.camp9.org/join/

Update April 9, 2020:

CLARIFICATION FOR MEETING STATE REQUIREMENT FOR 6TH VISIT SUPERVISION VIA TELEHEALTH/VIRTUAL PLATFORM

We have received a few questions regarding fulfillment of State regulated, 6^th visit COTA supervision requirements via Telehealth. For clinicians providing Telehealth services through Medicaid and Private Insurers, the process is much like it was prior to COVID-19, though services may be provided through Telehealth format.

How can this be utilized in the SNF setting, where OTs/OTAs are not recognized Telehealth providers? According to Practice Act Rule 4915 D, the OT has to “periodically (defined as every 6^th visit or once a month) re-evaluate and document the client’s occupational performance and performance skills”. In addition, Practice Act Rule 4919 A and B state that the OT must periodically and “systematically review all aspects of the individual occupational therapy programs for effectiveness and efficiency” as well as “systematically review the quality and appropriateness of total services delivered.”

****Therefore, if the therapist provides supervision via Telehealth, in collaboration with the COTA providing the hands-on portion of the supervisory visit, the COTA would need to document “OT supervised this treatment session via live video conference, with direct COTA collaboration, as COTA provided hands on treatment. During this collaborative visit, OT assessed patient’s status, response to intervention, remaining deficits, and effectiveness of current plan of care. Details will be noted by the OT in the upcoming Progress Report.”

Please note: The only person that bills Medicare for therapy services, at this point in time, is the person providing the hands-on intervention. In this scenario, the OT WOULD NOT BILL any time.

Information will be updated as Agencies make ongoing changes. If you are a LOTA member, please log in to www.lota.org for access to email addresses if you have further questions.

Update April 3, 2020:

WEEKLY LEGISLATIVE UPDATE

Today should have marked the conclusion of the Fourth Week of the 2020 Regular Session of the Legislature with all of the bill movement, debates, amendments and compromises, but instead, the legislature came in for a few hours, then cut off the lights without specifying a date that they will return. When the legislature adjourned after the first week, they set March 31^st as the day to return because, constitutionally, the 31^st was the last day they could file bills during the late filing period. The House and the Senate had also scheduled ten committee meetings this week and all ten were cancelled. The House needed 53 members to conduct business, and the Senate needed 20 members to conduct business and by all accounts, each chamber had the minimum with all of the members spread out practicing social distancing. The House filed 145 new bills, and the Senate filed 80 new bills but their outcome is less than certain. In a rare procedural motion, the House and Senate adjourned “upon notice of the presiding officer,” which means that there is no date of return and we will have to wait for legislative leadership to call legislators back to the capitol. So assuming the earliest we come back in session is May 1^st, and we know the session must adjourn sine die June 1^st, that leaves less than 30 days to get the state’s business done. The President of the Senate and Speaker of the House has instructed their Chairman to prioritize bills pending in their committees, but what exactly that means and what that looks like is really anybody’s guess at this point. The Budget will obviously take priority and must be in place and balanced prior to the start of the new fiscal year July 1. However, Senate President Page Cortez issued a dire warning to his Senate members. He said none of the fiscal experts can say what the economic impacts are going to be with any certainty, whether oil prices will bounce back, and how the federal dollars will assist the state . We likely will not know the real economic forecasts until the Fall. As Louisiana did after Hurricane Katrina, I believe a special session of the legislature is very likely later this year.

So while the legislature came in and left, the State of Louisiana remains focused on trying to “flatten the curve” and stall the increasing COVID-19 epidemic. On Thursday, Louisiana saw an increase of 42% of new cases which was significant, and the Governor has cautioned that this jump may have more to do with more testing results than new cases. Also on Wednesday, the number of patients requiring hospitalizations grew by 10%. The models seem to show that the need for medical resources will peak next week, when up to 1,730 ventilators and 8,000 hospital beds will be needed for coronavirus patients and the number of ventilators needed is more than twice the number currently available. Thursday numbers showed 9,150 cases, 310 dead, and 1639 in the hospital. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html Two State Representatives are currently hospitalized: Rep. Ted James from Baton Rouge was hospitalized with pneumonia and Rep. Reggie Bagala from Cut Off is on a ventilator. Louisiana prays for their healing. The Governor yesterday extended the Stay at Home Order until April 30^th. You can read the order here.

https://gov.louisiana.gov/assets/Proclamations/2020/41-JBE-2020-Stay-At-Home-Extended.pdf

Kevin Hayes, Hayes Strategic Solutions

LOTA Lobbyist

We hope that this again proves the value and worth of the Louisiana Occupational Therapy Association. If you are not a member, please click the link below and join us in the fight!

http://lota.camp9.org/join/

***Legislative updates are usually reserved for members. If you are not a current member, please join LOTA, as we continue to advocate for our profession during these times and ALWAYS!

http://lota.camp9.org/join/

Update March 31, 2020:

TELEHEALTH UPDATE: AWAITING CLARIFICATION FOR REIMBURSEMENT SPECIFICATIONS

As we are excited over the federal recognition from last night, we are awaiting clarification from AOTA/CMS on specifics for reimbursement. News will be released to you as soon as we get it.

Also, we ask that everyone send a special thanks to LSBME for their quick response to our request for action regarding OTAs being added to the Louisiana Telehealth Act!

In order to avoid flooding him with emails, please use this link to sign our 'Thank You Card' to LSBME: https://www.groupgreeting.com/sign/6f05b33214ac98e

Updates March 30, 2020:

TELEHEALTH UPDATE: FEDERAL WIN - MEDICARE NOW COVERS OCCUPATIONAL THERAPY TELEHEALTH SERVICES

A final update for the day, and ANOTHER VICTORY to report!! LOTA has advocated for our profession by reaching out to our lobbyist, LSBME, Louisiana Department of Health, Governor's Office, Legislators, AOTA, and CMS. Thank you to all that sent personal correspondence as well! Please click on the link below to read about the new CMS Guidelines that allows for therapists to provide Telehealth to Medicare patients, during the COVID-19 pandemic. Today has been a win for our patients from infants to elderly and from assistants to therapists. Let's keep this momentum going! There is power in numbers and we need your membership!

Please click on the link below to read all about the new CMS Guidelines that allow for Medicare Telehealth for all levels of Occupational Therapy services!

https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

Click the link below to see Telehealth Codes, including OT evaluations and treatment codes.

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

This is yet another example of the value and worth of the Louisiana Occupational Therapy Association. If you are not a member, please join us in the fight!

TELEHEALTH UPDATE: STATE WIN - COTAs CAN NOW PRACTICE IN THE STATE OF LA

Dear All Occupational Therapy Practitioners,

After much hard work, persistence, and collaboration, LOTA can proudly announce that OTAs can now practice Telehealth in Louisiana! WOOHOO!! We would like to thank Dr. Culotta of LSBME, Ms. Aycock of LDH, and all others involved for their willingness and ability to address our concerns and requests in such a timely manner. We have the utmost respect for the support that our state government has shown, allowing us to best serve our patients during this pandemic. Thank you to all who signed the petition, advocating for our patients and the services we provide.

We are so excited for this HUGE VICTORY!!... just in time for OT month!

Please click on the link below to read the full letter from LSBME.

Letter to OTs and OTAs.pdf

We hope that this again proves the EXTREME value and worth of the Louisiana Occupational Therapy Association. If you are not a member, please click the link below and join us in the fight!

Update March 27, 2020:

LEGISLATIVE UPDATE FROM OUR LOBBYIST

What should be a report on the third week of the legislative session, instead in this time of crisis, is a report on more cancellations and the continued spread of Coronavirus in Louisiana.

The Louisiana Legislature will come into Session on Tuesday at 11:00 am. The purpose of them convening is to receive any late bill filings as the constitutional deadline to file such is Tuesday at 6:00 pm. There is likely to be just a few bills filed and I think we will see a skeleton crew of legislators in town, they need 20 in the Senate and 53 in the House to conduct business. This will allow legislators to spread out in their respective chambers and get the work done that day. There had been 10 committees scheduled to meet next week but all of those have been cancelled. Obviously these are unprecedented times, but I think we will see them come into session then adjourn until the week of April 13^th. Based on the trajectory of the virus I do not know how realistic that date would be. While speaking with legislators this week, it is apparent that many of them do not want to come back to the Capitol at this time but they recognize the importance of developing and passing a budget prior to June 1^st when the constitution requires the Regular Session to adjourn Sine Die. It is estimated when you take into account the price of oil, the loss of sales tax and the loss of all gaming revenue, the impact on our budget could be as great as $50 million per week. I will have a much better idea Tuesday of what the future of this session will likely look like.

In the three weeks that this session should have been going on, Louisiana has seen the number of cases grow from 1 on March 9^th when the legislature gaveled in to 2,746 cases today with 119 dead. This website is updated every day at Noon. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html From Thursday to Friday, the number of positive cases grew by more than 400. The governor continues to warn of ‘flattening the curve” in his daily press conferences. This link provides all of the latest information from the Governor’s Office https://gov.louisiana.gov/coronavirus/ . Louisiana continues to have a stay at home order in effect. Link attached. https://gov.louisiana.gov/assets/Proclamations/2020/JBE-33-2020.pdf This week Louisiana was given the major disaster declaration by President Trump. This means the federal government has acknowledged that the disaster exceeds the response capabilities of state and local governments and that long-term recovery assistance is needed. https://gov.louisiana.gov/index.cfm/newsroom/detail/2433 Orleans Parish continues to the epicenter and is ranked in the top 6 counties/parishes and Louisiana’s cases per capita is higher than any state or country in the world! Interestingly, despite the Trump Edwards feud during the Fall elections, Trump is now praising the work Edwards is doing in Louisiana on this crisis. https://www.theadvocate.com/baton_rouge/news/coronavirus/article_5ffae176-6fce-11ea-802d-9fa4e9136cc1.html

- Kevin Hayes, Hayes Strategic Solutions

Update March 26, 2020:

UPDATED TELEHEALTH/E-VISITS CLARIFICATION FROM LSBME & LOTA:

LSBME has confirmed that, in order for occupational therapy services to be safely provided during this pandemic, Telehealth may be utilized by Louisiana licensed Occupational Therapists (but not by OT assistants).

The Telehealth treatment session MUST maintain AOTA Standards of Practice. Please remember that our profession plays a critical role in achieving and maximizing quality of life for our patients. When it is safe and possible, hands on intervention, following appropriate COVID-19 precautions, should be utilized.

**This clarification serves to verify permitted practice by LSBME; this is not a guarantee of coverage. LOTA continues to work with State Officials and Insurance Providers, regarding coverage for our services.

Allowable via Telehealth when an Occupational Therapist is unable to be on-site with a patient; for Medicaid, private pay, and insurance companies OTHER than Medicare (again, clarify with the provider prior to initiation of treatment):

Patient Evaluation
Patient Re-Certification
Individualized Treatment Session, maintaining USUAL Standards of Practice
Supervisory session to meet 6^th visit requirements
COTA supervision requirements can be met through direct observation of treatment sessions

Telehealth remains restricted, by Medicare, for both Part A and Part B patients.

Medicare Part A, neither e-visits nor Telehealth, have been approved (for ANY discipline, not just OT).

Medicare Part B, e-visits are allowed in certain scenarios. Reimbursement does not reflect level of expertise, and this is being fought by AOTA, APTA, and ASHA.

Clarification: Telehealth and E-Vists may be utilized by OTs ONLY - not by COTAs.

Here is a link for more information:

http://www.aota.org/Practice/Manage/telehealth/Billing-Medicare-Evisit

**If/when CMS expands Telehealth to Medicare Part A patients, we are prepared to implement at the State level. AOTA is hoping to hear of further expansion of allowable services as early as this week. Please advocate for our elderly! Contact your legislators to encourage them to push CMS to include therapy as recognized Telehealth providers (not just e-visit for Part B), as long as COVID-19 precautions are in practice.

The National Association of Rehabilitation Providers and Agencies has an article and a link for easy access to write to your legislators: Ask Congress to Protect Therapy Patients by Allowing Medicare Payment for Telehealth During the COVID-19 Outbreak https://www.congressweb.com/NARA#/

LOTA would like to thank Louisiana’s OT Advisory Committee for their time and efforts, in consultation with LSBME, to move these regulations forward. Thank you to all LOTA members and practitioners that have placed advocacy calls and sent letters to various government officials and insurance companies to facilitate coverage of skilled and medically necessary occupational therapy services.

**If you are not a LOTA member, you may go to www.lota.org to join or renew your membership. There is strength in numbers. LOTA will continue to work for you and send updates as timely as possible.

Update March 25, 2020:

ADDITIONAL RESOURCES PROVIDED BY AOTA

The National Governors Association has a new resource.

What steps have states taken to address coronavirus?

https://www.nga.org/coronavirus/#states

The Excel sheet summarizes the actions; the page includes URLs to the different orders. These orders are critical because they give governors to take actions related to licensure, telehealth, Medicaid and more.

State Emergency/Public Health Emergency Declarations (All States/Territories)

State emergency/public health emergency declarations have been issued for each state and territory, as well as the District of Columbia.

- Chuck Willmarth, Vice President, AOTA Health Policy and State Affairs

Updates March 24, 2020:

PROVIDING CARE IN COVID-19 PANDEMIC

Current and Future LOTA Members,

As OT practitioners in this state, many of us are feeling pressure to delay any care that can safely be postponed during this COVID-19 pandemic, while we also know the importance of the medically necessary treatment we provide on a daily basis. In this unique crisis of the COVID-19, the guidance is not black and white and significant clinical reasoning and judgement is necessary. Your geographic location likely plays a role.

Consider the time-sensitive nature of the interventions your patients require, along with their risk of being exposed through your treatments. Your risk-benefit analysis should take into consideration: diagnosis, support available, number of visits required, etc. If you do not have guidance from a supervisor and are not confident in your judgment, LOTA recommends that you consult with your care team or supervising physician for clarification.

We are sharing this excellent article created by AOTA that provides more detailed information along with additional resources to aid your clinical decision making during this time:

The Role of Occupational Therapy: Providing Care in a Pandemic http://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/OT-Pandemic.aspx

RESPONSE TO RECENT TELEHEALTH QUESTIONS:

Find below a link to multiple resources provided by AOTA, a memo from Kristen w/ AOTA, and a statement regarding Supervisory/COTA requirements.

Great Telehealth Resources from AOTA: https://www.aota.org/Practice/Manage/telehealth.aspx

Tele Health Advocacy - Kristen Neville, AOTA Manager of State Affairs

"The US Department of Homeland Security issued the below linked memo on Essential Critical Infrastructure Workers During the COVID-19 Response. This names OTs and OTAs as essential critical infrastructure workers, along with PTs and PTAs: https://www.cisa.gov/sites/default/files/publications/CISA-Guidance-on-Essential-Critical-Infrastructure-Workers-1-20-508c.pdf

I’ve also attached a document (https://www.aota.org/~/media/Corporate/Files/Advocacy/Federal/Fact-Sheets/Cost-Effective-Solutions-for-a-Changing-Health-System.pdf), co-written by our VP of Federal Affairs, Heather Parsons, who is an OT, on how OT is a cost-effective solution in our healthcare system. It always helps to share with Medicaid agencies and insurers information about how OT can save them money.

I hope this helps."

-Kristen Neville, AOTA Manager of State Affairs

Statement on Supervisory/COTA Requirements:

Please know that LOTA has been in contact with OTAC of LSBME regarding COTAs and Telehealth. We are expecting to hear from them soon to set temporary rules, possibly as early as Wednesday.

Update March 23, 2020:

CALL TO ACTION UPDATE REGARDING IDEA:

Fortunately, Chairman Alexander withdrew his provision in the pending stimulus bill that would give the Secretary of Education authority to approve state waiver requests for any statutory and/or regulatory requirement of the IDEA for 1 year and extensions may also apply. While this is a victory, we need to and will remain alert!!

BLUE CROSS BLUE SHIELD and UNITED HEALTHCARE TO COVER TELEHEALTH:

Thanks to the collaboration of LOTA, LPTA and LSHA, Blue Cross Blue Shield and United Healthcare have agreed to cover Telehealth services in Louisiana!!!

While this is a victory, Cigna and Aetna are denying coverage. We still need to take action and have professionals reach out to our congressional contacts:

Senator Bill Cassidy

www.cassidy.senate.gov/contact

Senator John Kennedy

www.kennedy.senate.gov/public/email-me

Find your U.S. Representative and send them an email as well:

https://www.house.gov/represtatives/find-your-representative

Feel free to use the letter template below:

Dear (Insert Name),

Cigna / and Aetna are denying coverage for their beneficiaries to participate in telehealth in the therapy sector for occupational therapy, physical therapy, and speech therapy. I am asking for your help to start the change needed so children can continue with their treatment plans while quarantined and social distancing.

In several parishes, many businesses have been told to shut down due to widespread cases of COVID-19 being reported. According to the newly released CDC guidelines, the President of the United States, as well as state and local officials have stated that we are to immediately implement social distancing and to avoid any gatherings of 10 people or more. Many clinics have more than 10 employees. This alone exceeds the CDC recommendations. We are completely unable to provide traditional in-person therapy at our normal capacity and are being advised by our therapy governing bodies and officials to move all therapy services to telehealth. There are a number of reasons why we believe that Insurance companies should be pro-actively working to help small businesses and other businesses overcome the hurdle of being reimbursed by insurance providers for all telehealth services. We are being told by Cigna / Aetna that they will not allow all plans to accept and reimburse for Occupational Therapy, Speech Therapy, and Physical Therapy services due to CMS Guidelines. However, as of 12:12 pm on 3/17/20, the following presser was released:

“The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.”

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit the risk of exposure and the spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19)."

This expansion of these CMS rules (which all private insurance carriers follow) should immediately, and retroactively, be applied to the therapy sector during the time the government recommends as many as possible work from home and for which telehealth has been applied as a therapy modality. This should absolutely include therapists across the country to provide continued therapy services for our most vulnerable populations that cannot risk receiving therapy in person. Additionally, employers cannot risk the safety and well-being of their staff during this serious COVID-19 outbreak.

Please see the following reasons for why we believe we should be reimbursed for services rendered via telehealth and that all insurance carriers should allow their beneficiaries therapy benefits to apply to telehealth during this global pandemic:

#1 As therapists we are required by our state licensing by-laws to never under any circumstances perform patient abandonment. Yet the government and insurance companies are implementing and enforcing strict rules and guidelines so that we are unable to provide much needed healthcare to our patients. Therapy is an essential and medically necessary need for many patients.

#2 Abandoning children and other patients without the ability to continue our plan of care will cause potential harm, a regression of skills required for activities of daily living and basic skills such as speaking, safely eating/drinking, walking, and being independent in self-help skills. This would directly impact the significant progress that they have worked so hard to achieve with direct guidance and support from their therapist. These patients would require additional care and will have to start their therapy plans completely over when this pandemic ends so that they can regain skills within functional limits for activities of daily living.

#3 Telehealth and telerehab are proven and accepted therapy modalities that are occurring in real-time through various platforms. Telehealth is provided via one on one therapy with our patients. This is within our scope of practice and ability of care. Our governing bodies for therapy, ASHA, AOTA, APTA, TOTA, TPTA, and TSHA have all encouraged therapy providers to utilize teletherapy during this difficult time for our country, where social distancing is our only option to stay safe.

#4 We see children with diagnoses whose health will be severely and directly impacted by this limitation as many of them are immunocompromised. These patients are more susceptible to COVID-19 at a greater risk than the general population.

** Feeding therapy patients suffer from silent aspiration on foods and liquids which can lead to pneumonia. Without regular parent training and therapy regarding proper positioning and techniques, these children are at an immediate greater risk of infection, which then increases the risk of complications from COVID-19.

** Patients with speech and/or language deficits will no longer have a trained therapist on their side assisting them in improving their overall communication skills and quality of life. Their families may have difficulty understanding their basic wants and needs due to the lack of continued therapy.

** Children with muscular spasticity due to cerebral palsy and/or other genetic anomalies need to participate in individualized therapeutic stretching/exercise protocols that are monitored and updated by skilled licensed therapists on a regular basis. Through telehealth, therapists are able to teach parents how to perform these specialized stretches in the home environment while interacting with a skilled licensed therapist to guide them through proper techniques to avoid any harm to the patients.

** Patients that struggle with emotional dysregulation who have made great progress with therapy at our clinic. If we can’t continue our plan of care with their families via telehealth, our patients would experience a regression of coping skills and would revert to negative behaviors impacting their daily lives and mental health.

** Many patients suffer from muscle weakness and poor coordination. With the help of continued guidance and support from skilled licensed therapists through the telehealth option, we can provide continuous activities that will improve their skills on a weekly basis rather than allowing for regression of skills to occur.

** Babies with torticollis (or a head tilt often accompanied by flattening of the head and facial asymmetry) would experience significant deficits in every area of life. Their vision, facial, head, and neck symmetry, gross and fine motor skills would all be negatively impacted by lack of therapy and parent education. These deficits which are easily treated with physical and occupational therapy would linger later into their lives which is medically negligent. We have the ability to use telehealth to guide and treat these patients in a timely manner to avoid any long-term damage.

#5 As therapy practitioners we agree to do no harm. The limitation in various insurance plans/carriers to not allow telehealth, even during this global crisis, is directly causing immediate harm to our patients and should be considered medically negligent.

Not allowing therapy via telehealth during this global crisis would negatively impact thousands of patients, hundreds of small businesses, our communities, and the nation as a whole as this virus continues to spread. Our only safe option for service delivery is via telehealth for one of our most vulnerable populations.

This is an urgent need for all insurers to include the therapy sector in the newly released CMS guideline expansion/waiver and allow telehealth as a therapeutic modality regardless of the insurance plan.

Update March 20, 2020:

LEGISLATIVE UPDATE FROM LOTA's LOBBYIST, KEVIN HAYES

Louisiana at this time has one of the highest rate of cases per capita in the United States, the fourth highest number of cases, and Orleans Parish ranks in the top 7 counties/parishes. Last Friday, there were 36 cases. This morning, there are 479 reported cases and 11 people have died. This link will give a good explanation of the cases, locations, trends etc. https://www.nola.com/news/coronavirus/article_7cb2af1c-6414-11ea-b729-93612370dd94.html

The Governor, earlier this week, closed down all schools, bars, restaurants (except for take-out), gyms, dental offices, and many others. His latest Executive Order was issued yesterday, and I have included here: JBE-32-20-Additional-Measures-For-Covid-19.pdf

During Thursday’s telephone conference with the Governors and the President, our Governor asked the President for immediate help with medical facilities, including the VA Hospital in New Orleans, saying that in the next seven (7) days Louisiana will exceed the health care capacity. Confirmed cases include New Orleans Saints Head Coach Sean Payton and Louisiana Department of Transportation Secretary Dr. Shawn Wilson.

The Louisiana Legislature on Monday adjourned until Tuesday March 31st and no bills have moved this session. March 31st is an important date as that is the last day for late introduction of bills; however, there is likely to not be many if any. The legislature is trying to figure the best way to handle the key bills like the budget and funding of K-12 education through the Minimum Foundation Program and no decisions have been made as of yet. The picture below is from the Baton Rouge Advocate on Monday showing me entering the Capitol to testify in what was the last committee meeting held before adjournment. Temperatures were checked, and it was quite a strange feeling entering a building generally filled with people during session, but not that day! In fact, on Thursday, the Capitol was closed and locked down with all employees being forced to work from home.

I will continue to keep you posted daily on the crisis here in Louisiana. Stay safe and healthy.

Kevin Hayes

LOTA Lobbyist

Hayes Strategic Solutions, LLC

Update March 19, 2020:

COVID-19 UPDATE FROM LOTA's PAST PRESIDENT, PRESIDENT, & VICE PRESIDENT

Good evening LOTA Membership,

First and foremost, I would like to let everyone know that YOUR Association has been fervently fielding questions, concerns, and notifications in order to bring this information to you as timely as possible. We had to await clarification from the necessary entities, in order to provide you with solid and supported information. I will be to the point/brief in presenting Hot topic information to you. Please expect multiple follow-up emails from LOTA, as we ask for your support in contacting legislators and officials, to maximize our impact and capitalize on this opportunity to ensure the provision of OT services to our Louisiana residents.

1. Clarification on LDH Notice RE: Medical and Surgical Procedures 3-18-2020

*** Occupational Therapy IS NOT (nor is any other therapy discipline) being restricted by this Public Health Notice. Though we bill “procedure codes” for outpatient therapy services, this notification is meant to provide guidance to those performing elective procedures/surgeries (such as non-emergent knee replacements, sinus surgery, etc.).

2. Provision of Occupational Therapy Services via Telehealth

****While LSBME has not yet written rules for Telehealth, the existing state law allows for, and governs, the use of telehealth by OTs in this critical time. This is LA RS 40:1223.1 to 1223.5. I have included a file below of these laws for your convenience. The law will always supersede any rules that LSBME would make. Remember that Telehealth should be used as a tool to provide quality, skilled, and medically necessary OT services. These services MUST meet the same standards of care as hands on OT intervention, in accordance with AOTA Standards of Practice. In addition, clinical judgment is required, as we must administer ONLY interventions/services that are safe to provide utilizing Telehealth. Telehealth IS NOT an adequate substitute for an intervention that can only be safely and effectively performed with a clinician’s hands on the patient. Abuse of this platform will only hurt our profession in the long run. Please report malpractice to LSBME. The OT Advisory Committee has submitted Rules for Telehealth, which will provide additional clarification and guidance. Those rules will be released once they have been reviewed by LSBME’s legal team, which may be after the Corona virus pandemic is behind us. PLEASE NOTE: this statement DOES NOT serve to guarantee payment. CMS has released many emergency advisories, including one that loosens restrictions on use of HIPAA compliant platforms (some recommended platforms will be included in subsequent emails). It is the responsibility of the clinician to check with the patient’s insurance provider in order to ensure therapy services, via Telehealth, would be covered.

Guidance: See the links below for the Telehealth Law and the HIPAA website.

Louisiana Telehealth Access Act: http://lota.camp9.org/resources/telheatn%20RS40%201223.1%20to.5[15983].pdf

COVID-19 and HIPPA: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

MEMBERS, please email LOTA if you have any additional questions. We will do our best to answer them in a timely manner.

*Membership Matters: LOTA has heard from concerned clinicians, many of whom are not members. It is time to work together to further the occupational therapy profession in Louisiana. LOTA funds our lobbyist and gives us a voice in the legislative arena. LOTA does not have the funding necessary to work for our profession without membership. LOTA works on behalf of ALL clinicians in Louisiana; if you are not a member, it’s time to pay your dues.

Thank you everyone for your support. We will get through these times, and it is my prayer that they will serve to unite our profession. There is strength in numbers.

Sincerely,

Danielle Keyser, MS, LOTR, GTC

LOTA Standards of Practice/Past President

Tiffany Stafford Twickler, MOT, LOTR

LOTA President

Elise Kelone Pearce, MOT, LOTR, CAPS, LSVT BIG Certified Practitioner

LOTA Vice President

Additional Resources provided to LOTA by AOTA:

What steps have states taken to address coronavirus?

State Emergency/Public Health Emergency Declarations (All States/Territories)

State emergency/public health emergency declarations have been issued for each state and territory, as well as the District of Columbia.

- Chuck Willmarth, Vice President, AOTA Health Policy and State Affairs

Stateside has created a chart with state legislative actions, executive agency actions, gubernatorial actions, and local government actions related to the outbreak of the coronavirus: https://www.stateside.com/blog/2020-state-government-responses-covid-19

The Center for Connected Health Policy (CCHPCA) has created a chart of state actions taken to remove policy barriers to telehealth utilization: https://www.cchpca.org/resources/covid-19-related-state-actions

The National Conference of State Legislatures (NCSL) has compiled state legislation responding to COVID-19: https://www.ncsl.org/research/health/state-action-on-coronavirus-covid-19.aspx

The Council of State Governments (CSG) has also compiled state-by-state resources such as executive orders, legislative sessions by state, state COVID-19 websites and resources, other mandates, etc: https://web.csg.org/covid19/

We hope you and your loved ones remain as safe as possible. Thank YOU for your commitment to serving your clients and making a difference in their lives even throughout this time of crisis.

linda@rivermgt.com

(225) 291-2806

LOTA, PO Box 14806

Baton Rouge, LA 70898