As the 2014 legislative sessions came to a close in states across the country, both Connecticut and Tennessee took an important step toward protecting occupational therapy clients from rapidly rising health care costs. Both states passed legislation limiting copayments and other cost sharing mechanisms for OT.
This legislation attempts to prevent health insurers from shifting cost sharing requirements—copayments, coinsurance and deductibles—to the client as insurers and employers frequently classify therapy services as “specialty care.” Without the changes enacted in this fair cost-sharing legislation, more clients would likely reduce the frequency of therapy or forego it completely because their portion of the cost is too burdensome.
In Connecticut, SB 10 limits copayments to no more than $30 per visit. This limitation applies to individual and group health insurance policies beginning January 1, 2015. The enactment of this legislation was a long and difficult battle. The Connecticut legislature passed a similar limit for physical therapy in 2013, but attempts to include OT in the measure last year were rejected. Throughout the 2013 interim and the 2014 session, the Connecticut Occupational Therapy Association lobbied hard for an amendment to include OT under the requirements of the copayment law. Initial legislation stalled because of procedural gridlock, but SB 10 was amended in the final days of the legislature to revive and ultimately pass the bill.
Tennessee SB 726 takes a different approach to limiting coast sharing. Under the bill, a health insurer must offer at least one employer-based plan that limits the copayment and coinsurance for OT to an amount that is not greater than the copayment and coinsurance for visiting a primary care physician. The bill also includes the same protections for physical therapy and chiropractic services. This bill also went through a two-year journey to enactment, but ultimately passed unanimously through the legislature.
Tennessee and Connecticut are the fourth and fifth states to enact a limit on copayments for OT services. Arkansas, Kentucky, and South Dakota are the only other states to afford this protection to OT clients. Similar legislation was considered in 13 additional states during the 2014 legislative sessions.
With similar proposals still active in other states this session and new measures expected to be introduced next year, AOTA and state associations will continue to monitor this issue and advocate for fair cost-sharing reforms.