Last month, the Athletic Trainers’ advisor to the Office of
Professional regulation (OPR), Mike Landsberg ATC and their President, Denise
Alosa ATC contacted me to discuss language for legislation they are proposing
to mandate insurance reimbursement for the AT evaluation and AT re-evaluation
billing codes. I worked with the State Government affairs office of the APTA to
draft language that would be most acceptable to PTs if the legislation should
pass. I met with the ATs and discussed the proposed language and shared the
draft language for inclusion.
Soon after that, Chris Winters, Director of OPR, wrote a
strong letter to John Bond, Director of Provider Relations at BCBS of VT,
encouraging him ask BCBS of VT to accept the AT codes and to work with both
VTATA and VTAPTA to define the areas of practice that are part of AT and/or PT
for purposes of reimbursement under the law.
I wrote to John Bond, asking that BCBS of VT respond
positively by accepting the codes, rather than face legislative mandate, and
offered the VTAPTA as a resource to help BCBS of VT define PT practice in comparison
to AT practice. Mr. Bond responded with a brief letter thanking me. Now we and
the ATs are waiting for a decision.
The ATs will not wait long and are starting to move forward
to introduce their legislation. I have once again contacted Mr. Bond, urging
voluntary acceptance of the AT codes. I have also let the ATs know that,
although we have suggested language for their legislation, we are not in favor
of any legislation at all that mandates acceptance of the AT codes. We would
like to continue to work through the appropriate State agencies to enforce our
practice act as it is written.
I have included the language of the proposed AT bill below.
You can see that it includesa
completely new proposal in section C. Our lobbyist feels that it may be a
subtle way to set precedent for direct access for ATs in the future. Please
respond to me directly with your feedback on any part of the proposed legislation,
so that we can testify if and when it comes forward. I will continue to keep
all of you up to date.
Catherine Sells PT
President
VT APTA
Proposed Legislation:
ACT 141
"To the extent a health insurance plan provides coverage for a particular
type of health service or for any particular medical condition that is within
the scope of practice of athletic trainers, a licensed athletic trainer who
acts within the scope of practice authorized by law shall not be denied
reimbursement by the health insurer for those covered services if the health
insurer would reimburse another health care provider for those services.
A health insurer shall not
deny reimbursement for the evaluation code specific to Athletic Training
if they reimburse for the specific evaluation codes for physical therapy and
occupational therapy. A health insurer may require that the athletic
trainer services be provided by a licensed athletic trainer under contract with
the insurer. Services provided by athletic trainers may be subject to
reasonable deductibles, co-payment and co-insurance amounts, fee or benefit
limits, practice parameters, and utilization review consistent with applicable
rules adopted by the department of banking, insurance, securities, and health
care administration; provided that the amounts, limits, and review shall not
function to direct treatment in a manner unfairly discriminative against
athletic trainer care, and collectively shall be no more restrictive than those
applicable under the same policy for care or services provided by other health
care providers but allowing for the management of the benefit consistent with
variations in practice patterns and treatment modalities among different types
of health care providers. Nothing in this section shall be construed as
impeding or preventing either the provision or coverage of health care services
by licensed athletic trainers within the lawful scope of athletic trainer
practice.
AT Practice Act Referral Language
(A) Without further referral, to athletes participating in organized sports or
athletic teams at an interscholastic, intramural, instructional,
intercollegiate, amateur, or professional level.
(B) With a referral from a physician, osteopathic physician, podiatrist,
dentist, or chiropractor, to athletes or the physically active who have an
athletic or orthopedic injury and have been determined, by a physician's
examination, to be free of an underlying pathology that would affect treatment.
(C) Athletic Trainers may receive referrals from and make referrals to Physical
Therapists and Occupational Therapists provided a referral is in place from one
of the professionals listed in section (B) above and the patient meets the
criteria set above.
VT APTA Proposed language:
Here are the two options for our proposed wording changes to your amendment
"A" of Act 141 in our order of preference:
1) in place of "shall not deny reimbursement for" read "shall
cover" the evaluation code specific to Athletic Training....
2) after of "shall not deny reimbursement for the evaluation code
specific to Athletic Training" add " that is deemed appropriate and
medically necessary".....
We have no problem to adding "podiatrists" to "B".
As we discussed in our meeting, we have concerns about both the concept and
wording of "C": "Athletic Trainers may receive referrals from
and make referrals to Physical Therapists and Occupational Therapists provided
a referral is in place from one of the professionals listed in section (B)
above and the patient meets the criteria set above." I have sent a
review of our Thursday discussion to our Board and Leadership group and am
waiting for input. The initial feed back from the group had many questions and,
as a whole, was not positive. That feedback did not favor placing the
physician who made the original referral out of the decision-making loop.
