Log in


COVID-19 


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

** NOTICE **

Healthcare facility workers and first responders who are symptomatic are being urged to get tested at one of two two drive-through “Community-Based Testing Sites” in the Greater New Orleans Area.

https://ready.nola.gov/testing/ 


Quick Link to AOTA's COVID-19 Page:

AOTA's COVID-19 Resources/Information

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 consider joining now - we have strength in numbers and need your support! 

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 13th. 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 1st 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 9th 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 6th 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.

Alabama |  Alaska |  American Samoa  |  Arkansas |  Arizona |  California |  Colorado |  Connecticut |  District of Columbia |  

Delaware |  Florida |  Georgia |  Guam |  Hawaii |  Iowa |  Idaho |  Illinois |  Indiana |  Kansas |  Kentucky |  Louisiana |  

Massachusetts |  Maryland |  Maine |  Michigan |  Minnesota |  Missouri |  Mississippi |  Montana |  Nebraska |  Nevada |  

New Hampshire |  New Jersey |  New Mexico |  New York |  North Carolina |  North Dakota |  Northern Mariana Islands |  

Ohio |  Oklahoma |  Oregon |  Pennsylvania |  Puerto Rico |  Rhode Island |  South Carolina |  South Dakota |  Tennessee |  

Texas |  Utah |  Vermont |  Virgin Islands |  Virginia |  Washington |  West Virginia |  Wisconsin |  Wyoming

 

- 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 alertCALL 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 Acthttp://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:


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/


lalwood@aol.com

(225) 291-2806

LOTA, PO Box 14806

Baton Rouge, LA 70898


© Louisiana Occupational Therapy Association


Follow us:   

Powered by Wild Apricot Membership Software