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NCPTA Submits Comments to NC Division of Aging
and Adult Services Aging Policy Listening Sessions
 
June 28, 2018
 
The North Carolina Physical Therapy Association (NCPTA) Falls Prevention Special Interest Group (FPSIG), appreciates this opportunity to express its concerns about issues important to our profession and to North Carolina (NC) residents. The NCPTA FPSIG is committed to reducing the high rates of morbidity and mortality resulting from falls among older North Carolinians.  Between 2006 and 2016, the rate of death from falls increased from 26 deaths to 67.3 deaths per 100,000 NC seniors. In 2016 alone, falls among NC residents 66 years of age or older resulted in more than 61,000 Emergency Department visits, almost 14,000 hospitalizations, and just under 1000 deaths. With the ongoing Silver Tsunami, these numbers will increase significantly. This serious and worsening problem must be addressed, with attention to the specific areas of concern listed below.
  1. Primary falls prevention services are limited, and efforts to direct older adults to appropriate programs and services are often “hit or miss." The lack of resources and referral mechanisms is particularly pronounced in more rural and economically distressed parts of the state.  Although research indicates that falls incidence can be reduced by addressing modifiable risk factors, including polypharmacy, poor vision, lower limb weakness, poor balance, peripheral neuropathy, depression, and fear of falling, referring patients to appropriate falls prevention programs is a huge challenge across the continuum of care. Few incentives exist for the development of new evidence-based falls prevention programs. Programs that are already in existence often disappear when grant support ends or other sources of funding are depleted. Primary care providers, hospitalists, physical therapists, and other health professionals who specialize in areas other than balance/falls typically lack the time to address their patients’ risk factors for falls and to stay informed about community-based falls prevention programs in their area.

  2. Many existing falls prevention programs are not reaching the people who are at highest risk for falls. Programs commonly offered by Area Agencies on Aging (AAAs) include A Matter of Balance, Moving for Better Balance, and Enhanced Fitness. These programs generally are directed toward older adults who are functioning at a relatively high level and may not be at particularly high risk for falls. On the other hand, most NC regional AAAs do not provide funding for the Otago Exercise Program, an evidence-based program that was shown in a series of randomized controlled trials to reduce falls among community-dwelling older adults by approximately 35%. This program is most effective for individuals 80 years of age and older who are at greatest risk of falls. The Otago Exercise Program is on the National Council on Aging (NCOA) list of approved Title 3D programs. Group-based Otago exercise classes are being offered through NC Providing All-inclusive Care for the Elderly (PACE) and in a few retirement communities.  Expansion of offerings of both the individualized (home) and group versions of the Otago Exercise Program to additional NC communities, such as Skilled Nursing Facilities (SNF), Assisted Living Facilities (ALF) and Senior Centers could go a long way toward reducing falls among NC seniors.

    Currently, the greatest limitations in providing these services are lack of knowledge about the program and funding for trainers. Dr. Vicki Mercer, PT, PhD from UNC-CH established the Community Health and Mobility Partnership (CHAMP) in McDowell County almost 8 years ago with a grant from The Baxter International Foundation. CHAMP provides free, comprehensive falls risk screenings once per month from March through November for any seniors who want to participate. Participants who are identified as being at increased risk for falls and appropriate for the program are instructed in Otago home exercises and asked to return for monthly follow-up visits. CHAMP staffing is provided by college students in Health Science programs, with supervision by faculty and licensed clinicians. This program has been an amazing program for my current home community.  As an expansion of CHAMP, Tiffany Shubert, PT, PhD, who has researched the Otago Exercise Program for the past 5 years, will be providing training this fall in the western part of the state on the community-based group Otago Exercise Program. This training must be disseminated more widely to meet the needs of seniors throughout the state.

  3. North Carolina has a shortage of healthcare providers with appropriate training in safe and effective geriatric care. Improved training of the healthcare workforce in geriatric care will impact not only the incidence of falls, but also a number of other health outcomes for older adults, such as the frequency of medication errors and infections. We need affordable training in geriatrics for paraprofessionals and professionals to demonstrate continued competency and/or achieve geriatric specialty certification. This training could be provided by universities, community colleges, or AHECs to help meet the growing need for geriatric healthcare in NC.  A system to reward healthcare providers for their efforts in delivering top-quality care to NC seniors would be helpful in encouraging providers to pursue training.  The NCPTA FPSIG would be willing to partner with other organizations in exploring ways to create this type of system to increase the quality of care for NC seniors.

The NCPTA FPSIG supports the efforts of the AAAs in addressing other issues related to falls and physical therapy interventions for falls, including: dementia/ memory care; identification of and treatment for mental health concerns, such as anxiety and depression; the opioid epidemic; polypharmacy; safe, affordable housing; and increased funding for Medicaid. Physical therapy can be an effective treatment for many geriatric conditions and is often a better alternative than medication for treatment of pain.   

Another effort is the expansion of NC PACE Program, especially in rural North Carolina, where many physical therapists work in home health settings.  Expanding an existing PACE is more cost effective than creating a new PACE. There are existing PACE Programs in North Carolina that are ready and willing to expand, but there is a need for additional funds from the General Assembly for PACE expansion.  Any assistance in advocating for PACE expansion for our consumers would be greatly appreciated.  

 

Aging Policy Listening Sessions

The NC Division of Aging and Adult Services will hold Aging Policy Listening Sessions around the state in May and June. These Listening Sessions, which are co-hosted by the NC Association of Area Agencies on Aging, will help identify the needs of the state’s older citizens, disabled adults, and their caregivers.  The information gathered will be used to inform North Carolina’s 2019-2023 Aging Services Plan. Attendees may register to speak upon arrival at the meetings or in advance by completing the on-line Listening Session Sign-Up Form. Speakers will be limited to three minutes and are encouraged to provide a written copy of their comments when registering.

The dates and locations of the listening sessions are as follows:

May 8, 2018
The Folk-Art Center
Milepost 382 Blue Ridge Parkway
Asheville, NC
10 a.m. - 12 p.m.

May 22, 2018
Piedmont Triad Regional Council
1398 Carrollton Crossing Drive
Kernersville, NC  27284
10 a.m. - 12 p.m.

May 30, 2018
New Hanover Senior Resource Center
2222 S. College Rd. Wilmington, NC 28403
Wilmington, NC
10 a.m. - 12 p.m.

June 19, 2018
Pitt County Community Schools and Recreation Building
4561 County Home Road
Greenville, NC 27858
10 a.m. - 12 p.m.

June 27, 2018
Centralina Council of Governments
9815 David Taylor Drive
Suite 100
Charlotte, NC 28262

  

Medicaid Managed Care Concept Paper - Therapists Not Included

DHHS Medicaid issued a managed care concept paper,Prepaid Health Plan Network Adequacy and Accessibility Standardsrecently to consider standards for perspectives of beneficiaries, plans and providers on what each defines as an “adequate and accessible” network. The proposed network does not include physical therapists, occupational therapists, respiratory therapists or speech/language pathologists.


NCPTA will be advocating for the inclusion of therapists in theAppendix B: Providers Subject to Specialty Care Access Standards. We are encouraging members to also comment on these standards. Comments can be emailed to Medicaid, through March 29, 2018, attransformation@dhhs.nc.gov.

 
NCPTA Officials Attend Medicaid Opioid Stakeholders Meeting

The Medicaid Outpatient Specialized Therapies Stakeholder Committee held  a committee meeting on February 1 to discuss adult therapy services. Flo Moses, Director for Payor Relations and Liz Reeser, Payor Relations Committee member attended the meeting on behalf of  NCPTA .Medicaid’s Outpatient Specialized Therapies staff have been charged with developing policy recommendations to address the opioid crisis. Due to the complicated clinical coverage policy for therapy services for adults the group was asked to make new recommendations for therapy services for adults. 


The results of  a survey on services for adults was presented. Overwhelming the survey respondents felt that adults should be asked to be charged a co-pay for therapy and that 2 visits a month were optimum rather than 1 visit per month. The goals are to simplify the policy to make it easier for providers, reviewers, recipients and Division of Medical Assistance (DMA) staff and to support the mandates from the Department of Health and Human Services (DHHS). 

T
wo proposals were presented and agreed upon:

  1. Visits: 24 visits per year or 30 visits per year, as well as, 1 evaluation per year for PT, OT , ST. Both proposals will be sent to Fiscal Research for each proposals fiscal impact which could be $15 million or higher and require a legislative budget appropriation.

  2. Co-pays: $3 as suggested by the stakeholders or $4 as proposed by DMA to be consistent with CMS policy. Both proposals will also need to be submitted to CMS for review and approval. The stakeholders will be kept informed as the proposals proceed.