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May 15, 2005
Attn. Mr. (Ms)
McClellan
Center for Medicare and Medicaid Services
Department for Health and Human Services
PO Box 8012
Baltimore, MD, 21244-8012
Dear Mr. (Ms)
McClellan:
The Puerto Rican
Physiotherapy Association (APF) and the members of the Private
Practice Section (SPP), support CMS for emitting a final
regulation that established the standards for qualifications and
administration for the individuals that provide Physical Therapy
services to Medicare beneficiaries in offices owned by doctors.
To us, it seems
very opportune that the new regulations require that all physical
therapy services offered in offices owned by doctors and
considered incidental to professional medical service, apply the
same rules and conditions applied in any other ambulatory facility
where physical therapy services are offered to Medicare
beneficiaries.
Our organization
congratulates and supports this federal regulation that
establishes the reimbursement of incidental physical therapy
services to the medical professional service, only if the
professional that offers the service upholds the standards and
conditions that apply to physical therapy ambulatory services
offered by a physical therapist or by a physical therapy assistant.
The APF is an
organization that supports the physical therapists, physical
therapy assistants and physical therapy students, with a
membership of approximately 300 professionals. The academic
programs of Puerto Rico (Colegio de Profesiones Relacionadas con
la Salud, Recinto de Ciencias Médicas de la Universidad de Puerto
Rico and the Physical Therapy Graduate Program of Loma Linda
University, Loma Linda California), prepare Physical Therapy
professionals with a Masters Degree having graduated in Puerto
Rico 150 professionals with this grade. In Puerto Rico, there are
three Physical Therapy academic programs that offer an associate
degree in Physical Therapy.
The Private
Practice Section (SPP) groups the physiotherapists that provide
Physical Therapy in their offices that render private practice
services throughout all Puerto Rico. Our members are recognized as
legitimate providers of physical therapy services in all Puerto
Rico, and as such, by the majority of medical plans. All of our
members are participant providers of Medicare. In Puerto Rico,
there are approximately 42 physical therapy private practice
offices. They operate in accordance with the Department of Health
regulations, the conditions established by the Medicare Program,
and other regulatory agencies.
Our code of
ethics establishes that the members of this association respect
the laws and regulations that govern the practice of Physiotherapy
in Puerto Rico. We also established that the members of this
association protect this organization, the consumers, and the
profession from anti-ethical and illegal practices, as well as
incompetence.
We understand
that it was time to put a stop to the practice of physical therapy
in many medical offices in Puerto Rico where physical therapy
services are offered to beneficiaries of Medicare, and other
medical plans, under the model of incidental professional medical
service. Under this model, besides violating the federal
regulations of Medicare in Section 1862 Social Security Act, it
also violates Law 114 of June 29, 1962, as it was amended, which
regulates the practice of Physical Therapy in Puerto Rico.
This Act
establishes that the physical therapy assistant work under the
direct supervision of the physical therapist. In some medical
offices, where physical therapy services are offered by incidental
professional medical service, the supervision of the physical
therapy assistant is being performed by the doctor, who is not
authorized by Law 114. It’s important to point out that the
academic preparation of the physical therapy assistant gives him/her
the ability to assist the physical therapist in the application of
some modalities and therapeutic procedures delegated by the
physical therapist. This implies that when the doctor employs the
physical therapy assistant without the direct supervision of the
physical therapist and mostly when the doctor pretends to
supervise the physical therapy assistant, he/she is depriving the
patient from receiving a complete treatment, because the physical
therapy assistant is not authorized by law to practice all the
modalities, and procedures which represents a full physical
therapy service. This practice, besides affecting the quality and
effectiveness of physical therapy service, adversely affects the
components of security, economics, and free selection for the
service consumer.
The Puerto Rican
Physiotherapy Association (APF), and it’s Private Practice Section
(SPP), recognize the duly establishment of this federal regulation.
It is an achievement that will guarantee that the beneficiaries of
Medicare in Puerto Rico will receive the physical therapy service
that they deserve.
Recognizing your
jurisdiction, and fiscal reach, we exhort you to give strict
follow-up and vigilance to this matter to guarantee the
accomplishment of this federal regulation in Puerto Rico. We, as
an organization will be rigorous with our follow-up, orientation
to the community, and other groups that are affected, to
collaborate with the CMS to achieve the effective compliance with
this regulation in Puerto Rico.
Cordially,
Ada Nivia Rivera, PT, MPHE, CHES Lcda. Zenaida
Vélez Quiñones, MPT, PT
President APF
President SPP
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