CMS Revises OT Qualifications under Medicaid
The Centers for Medicare & Medicaid Services (CMS) have finalized a proposal to update Medicaid language on the personnel qualifications of occupational therapists and physical therapists. Per its final rule on Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction [CMS-9070-F], CMS will now use updated Medicare language on therapist qualifications for purposes of Medicaid.
AOTA has long advocated for an update to the Medicaid regulations that define qualified occupational therapists (OTs) and occupational therapy assistants (OTAs). Throughout 2010 and 2011 we were in contact with CMS about the issue, informing the agency that the law was outdated, inaccurate, and incomplete. We urged CMS to make the necessary changes to avoid any confusion in practice and reimbursement that could ultimately lead to widespread problems between OTs/OTAs and the Office of the Inspector General (OIG), CMS contractors, and state enforcement agencies. We also noted that revising the regulation for accuracy would be consistent with CMS policy, would resolve confusion surrounding the necessary qualifications for Medicaid providers, and would potentially improve the quality of care provided to Medicare and Medicaid beneficiaries without having any negative fiscal impact on states.
Last year, as a result of prolonged advocacy from AOTA, CMS proposed to remove the outdated qualifications language for OTs in the Medicaid regulations (42 CFR §440.110) and instead cross reference the updated language for OTs in the Medicare regulations (42 CFR §484.4). AOTA submitted comments in support of these efforts to finally make OT language consistent across Medicaid and Medicare and we further requested that CMS address regulatory inconsistencies for the definition of qualified OTAs.
In the final rule, CMS states the Medicaid regulation on OTs will now read: “A ‘qualified occupational therapist’ is an individual who meets personnel qualifications for an occupational therapist at [42 CFR] §484.4.” (77 Fed. Reg. 29002, 29031) CMS declined to take AOTA’s suggested action with regard to OTAs, though the agency did agree that “States utilizing PT or OT assistants would be well served to follow the Medicare definition found at 42 CFR 484.4, to ensure consistency across programs.” (Fed. Reg. 29020) AOTA is seeking additional clarification on this decision from CMS.
Changes are effective July 16, 2012.
Additional Resources -
AOTA: Letter to CMS on OT/OTA Qualifications (March 2, 2011) (members only)
AOTA: Comments on the Proposed Rule (December 21, 2011) (members only)
CMS Proposed Rule: 76 Fed. Reg. 65909 (October 24, 2011)
CMS Final Rule: 77 Fed. Reg. 29002 (May 16, 2012)
Medicare Regulation on OT and OTA Qualifications: 42 CFR §484.4 Personnel Qualifications