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Occupational Therapy: Part of the Health Care Solution

By Stephanie Yamkovenko

On March 23, President Obama signed health care reform into law. Despite months of delays and political changes in the Senate, the House of Representatives passed the Senate’s Patient Protection and Affordable Care Act by a close party-line vote on March 21. Watch the Legislative Action Center’s Health Care Hub for updated information, links to the legislative language, and additional analyses of the law in coming days and weeks.

AOTA advocacy efforts for the past year focused on maximizing opportunities for occupational therapy in health care reform, while eliminating or minimizing the impact of any potentially negative proposals. AOTA promoted “OT as Part of the Health Care Solution.” With the help of members’ individual advocacy and the work of Federal Affairs staff, the profession and clients of occupational therapy benefit from several key provisions in the new law.

The exceptions process to the Medicare therapy cap is extended until the end of 2010, which allows Medicare beneficiaries to receive medically necessary occupational therapy services beyond the $1,860 cap. The exceptions process extension allows clinicians to use their judgment to determine the amount and frequency of therapy services for their clients. 

Rehabilitation and habilitation services are now required services in the mandatory benefits package. When the law is fully implemented, practitioners should see a reduced number of denials of coverage for occupational therapy simply because an insurance company deems the service habilitative.

The new law protects occupational therapy’s scope of practice in orthotics and prosthetics. Due to AOTA advocacy and education about the role of occupational therapy with orthotics and prosthetics, the Senate Finance Committee excluded proposed provisions that would harm beneficiary access to necessary occupational therapy services. The law also specifically lists occupational therapy in workforce-related provisions, which provides occupational therapy practitioners with elevated recognition.

The continued advocacy efforts of AOTA members and staff in the past year resulted in major victories for the profession of occupational therapy in health care reform. Unfortunately, two provisions that were in the original House bill were not in the final law, including a 2-year extension of the exceptions process to the Medicare therapy cap and occupational therapists gaining initiating service status in Medicare home health.

The bill includes many opportunities for moving into new areas in Medicare and other programs.  Trials and explorations of chronic care management, medical homes, coordinated care, and wellness and prevention programs will be targets of advocacy to include occupational therapy as they are put forward.  Medicare has established a Center for Medical Innovations to implement many of these suggestions.

While celebrating the successes of the new health care reform law, AOTA continues to advocate for and share the message of occupational therapy with lawmakers.

Stephanie Yamkovenko is AOTA’s staff writer.