Kentucky Regulations
Public Protection Cabinet/Department of Insurance

March 24, 2020

Dear Therapeutic Association Members,

In an effort to give clarity to the intent of the interim guidance dated March 20, 2020 for the temporary closure of outpatient rehabilitation centers, this notice identifies specific diagnoses that are considered emergent and urgent for purposes of continued physical therapy, Occupational Therapy, and Speech Therapy services during this state of emergency and the procedures that health care professionals should follow to prevent the spread of COVID-19:

On March 6, 2020, Governor Andy Beshear signed Executive Order 2020-215 declaring a state of emergency in the Commonwealth due to the outbreak of the COVID-19 virus, a public health emergency. On March 17, 2020, Governor Beshear recommended that Physical Therapist, Occupational Therapist, and Speech Therapist only provide services for Emergent and Urgent needs beginning March 20, 2020. Therefore, pursuant to the authority in KRS Chapter 39A, KRS 194A.025, KRS 214.020 and Executive Order 2020-215, the Cabinet for Health and Family Services, Department of Public Health states that the following directives are in effect during the this state of emergency:

• To assist licensed healthcare professions in the exercise of their judgment, the following guidelines are offered:

o Emergent: Any healthcare service that, were it not provided, is at high risk of resulting in serious and/or irreparable harm to a patient if not provided within 24 hours.

o Urgent: Any healthcare service that, were it not provided, is at high risk of resulting in serious and/or irreparable harm to a patient if not provided within 24 hours to 30 days.

o Non-Urgent: Any healthcare service that, were it not provided, is unlikely to result in any serious and/or irreparable harm to a patient if not provided for more than 30 days.

• Emergent and urgent conditions include, but are not limited to the following:

o Acute orthopedic surgical recovery;

o Recovery from acute neurologic injury:

• Stroke

• Traumatic Brain Injury

o Acute recovery for patients needing swallowing, aspiration treatment

• Head and neck cancer patients

o Any condition that without the immediate use of therapeutic modalities would result in permanent and complete loss of function

Patients with any of the above conditions are not candidates for telehealth services in the acute phase of their recovery because they are at increased risk for a lifetime of disability if physical therapy services cannot be performed in-person with a licensed Physical, Occupational, or Speech therapist.

• Methods of reducing exposure and potential spread of COVID-19:

o Pre-screen each patient for illness by phone prior to every visit.

o Screen each patient for fever and respiratory symptoms (shortness of breath, new or change in cough, and sore throat) upon arrival at the treatment site.

o Focus on distancing as much as possible during the treatment.

o If possible, reduce the number of visits and shorten the duration of each visit.

o Minimize the number of employees (therapists only) in the outpatient clinic sites.

o Use personal protective equipment during treatment as available.

o Allow only one patient at a time in each clinic and no accompanying visitors.

In this rapidly evolving situation, the Cabinet for Health and Family Services encourages health care providers to be prepared for further guidance. For the most up-to-date information, visit the following websites:

CDC COVID-19 website: www.cdc.gov/covid19

KDPH COVID-19 website: www.KYCOVID19.ky.gov

Respectfully,

Inspector General

Adam Mather