Legislative Alerts

Legislative Action Alert and Update 11/13/2017

In recognition of the 2017 OT Centennial celebration, OOTA is including ALL Ohio OT/OTA licensees on updates regarding legislative efforts impacting OT practice in Ohio.

If you are not yet a member of OOTA, please consider adding your voice and support to these advocacy efforts by joining OOTA today!  All membership fees are reduced by 10% through the end of the year.

Happy Veterans Day/Weekend to all!

First, we wanted to send out some recent positive news from the federal level…

1.   Tricare Reimbursement of Occupational Therapy Assistant Services Advances in Congress; Policy to be Signed into Law by End of 2017

  • TRICARE (also known as the Civilian Health and Medical Program of the Uniformed Services, or CHAMPUS) previously did not recognize or reimburse services provided by occupational therapy assistants (OTAs) or physical therapist assistants (PTAs).
  • AOTA and APTA have advocated hard this year for corrective language in the annual National Defense Authorization Act (NDAA) for FY 2018 that would cover services provided by OTAs and PTAs.
  • From AOTA’s update:

The corrective language was included in the annual NDAA, which authorizes the existence of the United States Military and related programs including TRICARE. Authorization bills for the National Defense must be passed every year.  On October 9, 2017 the House and Senate released their compromise NDAA language which included a section on “authorization of physical therapist assistants and occupational therapy assistants to provide services under Tricare.”

The House is scheduled to vote on the final bill next week, and the Senate intends to vote on the bill by early December. This will clear the way for the bill to be signed by the President before the end of 2017.  Once signed into law, the DOD will be required to update its policy manuals and regulatory guidance, and finally include occupational therapy assistants as TRICARE providers.

 Second, some positive news that will still require some grassroots organizing on our part…

2.   Congress Introduces Medicare Home Health Act

  • As many of you already know, occupational therapy is currently not recognized by Medicare as a “primary service” in home health, meaning an occupational therapist cannot “open” a new home health client’s case by doing the initial assessment.
  • AOTA’s significant advocacy efforts have resulted in new legislation, introduced September 25th in the House of Representatives as the Medicare Home Health Flexibility Act (H.R.3820). This bill would allow occupational therapists to open home health therapy cases by conducting the initial assessment and completing the required comprehensive assessments under Medicare. The legislation was introduced by Representatives Pat Meehan (R-PA), Lloyd Doggett (D-TX), Ryan Costello (R-PA), and Paul Tonko (D-NY) and is identical to a bill introduced in April (S.977) by Senators Ben Cardin (D-MD) and Dean Heller (R-NV).
  • From AOTA’s update (Bopp, 11/2/2017):

If the Home Health Flexibility Act were signed into law, occupational therapists would be able to open home health therapy cases, including conducting the initial assessment and completing the first comprehensive assessment. This would allow occupational therapists to be the first ones in the door, when they are the most appropriate profession, and reduce home health service delays in areas where access to physical therapy and speech-language pathology clinicians is limited. This would help to reduce Medicare costs related to service delays and ensure that clients have early access to occupational therapy when needed.

 Based on their proven expertise in optimizing outcomes for clients and improving efficiency, occupational therapists are already well qualified to conduct the initial and comprehensive home health assessments for Medicare, and they already perform these assessments for Medicaid and private insurance home health therapy cases. Among other things, the new requirements for the comprehensive assessments include assessing a client’s functional, cognitive, and psychosocial status—all key domains for occupational therapy. This assessment is then used to develop the client-centered plan of care.

 The bill would not alter Medicare’s criteria for establishing eligibility for the home health benefit, and it would apply only to rehabilitation cases. In addition, it has received a zero score from the Congressional Budget Office, which means it would not create added costs for the Medicare program. In Washington, legislation that has no cost is always easier to enact than legislation for which Congress must identify a funding source or “pay for.”

 Broad support for H.R.3820/S.977 from groups including the National Association of Home Care and Hospice, the American Physical Therapy Association, and the American Speech-Language-Hearing Association also increases the chances that Congress will address this issue.

 Members can help by contacting their representatives and senators to urge them to support H.R.3820/S.977.

 And last but not least, we may finally be able to get rid of…

3.   Bi-partisan Agreement Reached on Policy Framework to Permanently Repeal the Medicare Outpatient Therapy Cap

  • From AOTA: On October 26th, three Congressional Committees (with members from both the House and Senate) have agreed to the proposal but it has not yet been introduced as legislation.
  • Statement about the framework by the Ways and Means Committee
  • Statement about the framework by the Committee on Energy and Commerce
  • While the repeal of the arbitrary cap amount would be permanent, continued oversight of therapy utilization would occur through some existing activities, such as:
    • Use of the KX modifier to “certify medical necessity and reasonableness”
    • Targeted review of claims over a certain dollar threshold.
    • Without action by Congress by the end of 2017, the therapy cap will go back into effect. Please contact your legislators to request they support repeal of the therapy cap today.

If you have questions or comments regarding this update or any of the proposed legislation, please don’t hesitate to contact OOTA lobbyist Dan Hurley at dhurley@capitol-consulting.net or email questions to OOTA directly at webmaster@oota.org.