The Trump administration's Regulatory Relief to Support Economic Recovery executive order adopted in May encouraged all federal agencies to consider what could be done to create more efficient, responsive, and effective systems to help steer the country through the COVID-19 pandemic. APTA seized the opportunity to provide feedback on what policies should and shouldn't be retooled.

APTA provided comments to the U.S. Departments of Health and Human Services, Labor, Defense, Treasury, Housing and Urban Development, and Education, as well as the Social Security Administration. The letters cover a range of issues but share a common theme: leveraging the emergency order as an opportunity to improve patient care and public health into the future.

Here's a roundup of the letters we've written, with a brief synopsis of the recommendations we made. Copies of any of the letters can be obtained from advocacy@apta.org.

To: U.S. Department of Health and Human Services
Date: June 10, 2020
What we recommended: This letter, one of two sent to HHS Secretary Alex Azar, presses for the agency to work with Congress to permanently include PTs, PTAs, occupational therapists, and speech-language-hearing pathologists among the providers able to provide telehealth services to Medicare beneficiaries. It's a change that HHS can't accomplish without an amendment to the Social Security Act, so Congress also needs to be involved. The letter was sent jointly by APTA and 13 other groups including the association's Academy of Geriatric Physical Therapy, Home Health Section, Health Policy and Administration Section, and Private Practice Section. The Alliance for Physical Therapy Quality and Innovation, the American Health Care Association, and the American Speech-Language-Hearing Association also signed on.

To: U.S. Department of Health and Human Services
Date: June 5, 2020
What we recommended: This extensive letter covers multiple areas. In addition to again recommending permanent telehealth status for PTs and PTAs, we advocated for several other issues, including:

• More careful thought on the impact of proposed cuts to services billed by PTs and other providers in 2021 to pay for proposed increases in evaluation/management codes billed by physicians and other providers.
• Modification of the therapy plan of care certification requirement.
• Permanent authorization for PTAs to perform maintenance therapy under Medicare Part B.
• Flexibility for PTs to perform the initial and comprehensive assessments in home health when both nursing and therapy are ordered.
• Allowance for general supervision of PTAs in private practice.
• Requirement for functional ability and level-of-safety screenings during subsequent Medicare Annual Wellness Visits.
• Formal recognition of PTs and PTAs as essential health care providers by the Centers for Disease Control and Prevention.
• Development of Health Resources and Services Administration policies — including student loan forgiveness — that "assist health care workers who are on the frontlines of this national emergency."

To: U.S. Social Security Administration
Date: June 3
What we recommended: We believe the SSA should formally recognize PTs as an accepted medical source to provide the agency with medical evidence and opinions used in decision-making. Because PTs tend to see their patients more frequently than physicians do, PTs "are in a position to provide valuable evidence on a [SSI] claimant's disability status."

To: U.S. Department of the Treasury
Date: June 4
What we recommended: Our letter encouraged Treasury to promote wide physical activity through incentives such as a $1,000 per person tax break for annual sports and fitness-related expenses.

To: U.S. Department of Labor
Date: June 4
What we recommended: This letter focused on exemptions carved out for employers during the current health emergency that allow for denials of additional paid employee sick leave included in the Families First Coronavirus Response Act. Our concern is that the exemptions are being applied too widely, with many employers ignoring Labor's guidance to be "judicious" about denying access to additional leave. Our recommendation is that Labor consider a pathway allowing it to overturn an employer's decision if necessary. We also call for additional guidance to employers on judicious use of the exemption.

To: U.S. Department of Housing and Urban Development
Date: June 4
What we recommended: We call on HUD to "more distinctly recognize" the importance of physical activity, and to consider how community design can be improved to promote physical activity and active forms of transportation. 

To: U.S. Department of Defense
Date: June 4
What we recommended: Our letter asked DoD to direct its health care contractors to adopt telehealth for PTs and PTAs on a permanent basis, and to recognize PTs as primary care providers under TRICARE.

To: U.S. Department of Education
Date: June 4
What we recommended: The letter to DoE included requests to take additional steps in some areas and stop in its tracks in others. We recommended that DoE do more to promote physical activity, ensure equity in how services will be made up when schools reopen, and update the Medicaid School-Based Administrative Claiming Guide, which hasn't been updated since 2003. We also pressed DoE to promote student loan forgiveness policies "that help ensure that physical therapist services are available and accessible, particularly in rural and underserved communities." Our recommendations went in the other direction when it came to the Individuals with Disabilities Education Act, and the Rehabilitation Act, for which we stated that DoE should not institute any changes or waivers that weaken provisions in either law. We told DoE that "APTA is unwavering in our pursuit of educational equity."