Health Care Reform Implementation: AOTA Working for You

By Dan Brown

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama on March 23, 2010. AOTA was very active in the legislative process leading up to the passage and signing of the ACA, working to achieve victories such as inclusion of rehabilitation and habilitation in the essential benefits package.

But our work didn’t end when the ACA was signed into law. Implementation will continue through 2016 and beyond, and AOTA is closely following state and federal regulatory and other processes, providing comments and ensuring that the interests of the occupational therapy profession and your clients are advanced and protected.

The following FAQs are designed to let members know about some of the work we’ve been doing. Much more information is available on our Web site under Advocacy/Health Care Reform.

Q: What is AOTA doing to be sure occupational therapy services are covered by the ACA?

There are two large populations of people who will gain access to health insurance under the ACA. They include those newly eligible for Medicaid, and others who will receive tax credits to reduce the cost of private insurance purchased from online marketplaces, called health insurance exchanges. In both cases, certain benefits must be covered for these groups. They are called “essential health benefits” or EHBs. One category of the EHBs is “rehabilitative and habilitative services and devices.” That is where occupational therapy services are typically included. However, because in the past habilitative services were often excluded from health insurance coverage, there is a unique opportunity to influence how they will be defined for these new groups in the future. AOTA has been working to influence state and federal decision makers on this issue, and to make sure that coverage for occupational therapy services is included in the habilitation benefit. Our activities have included partnering with state OT associations, as well as other health care provider and disability advocacy organizations, to monitor activities throughout the country and be at the table when these important decisions are made. We have developed advocacy resources for our partners, including customized comment letters. We have also held conference calls to educate and strategize with state OT leaders, including some that were recorded as podcasts and are available for AOTA members to listen to. We also submit our own comment letters on proposed federal regulations, such as this one.

Q: Under the ACA, there will be some variations in the law by state. How is AOTA tracking and sharing that information?

The approach the federal government took to implement many portions of the ACA does allow for substantial state flexibility. That creates opportunities for localized advocacy, but it is challenging to monitor, as there are many more entities making important decisions. AOTA has contracted with Stateside Associates, a consulting firm, to assist us in monitoring important activities, such as key public meetings. We share the information we receive from Stateside with state OT associations in weekly reports. Stateside also provides us with periodic reports summarizing the status of certain issues across the country. In addition, AOTA has contracted with State Net, a database service, to track legislation and regulatory activities. We also share weekly reports with our state partners based on that information. There are a variety of other ways we maintain awareness of what is going on throughout the country, but one of the keys to doing so is maintaining open lines of communication with our partners. Through our relationships with state occupational therapy associations and other organizations, we can leverage resources that go beyond those we have internally.

Q: What long- and short-term issues is AOTA focusing on?

In the short term, AOTA is concentrating on ensuring that the definition of the habilitation benefit for the newly insured population includes coverage of occupational therapy services. In addition, we are advocating for the expansion of Medicaid eligibility, which is an option for states, to maximize the number of people who will gain access to occupational therapy and other services, including rehabilitative and mental/behavioral health services. In the long term, we are working on projects to identify opportunities for occupational therapy professionals as the health care delivery system evolves. The ACA, and other health care reform efforts, are attempting to change the structure of our health care system in ways that go beyond providing more people with health insurance. AOTA is working to ensure that the benefits of occupational therapy are acknowledged as those changes take place, and that occupational therapy is an integral part of the integrated and interdisciplinary care delivery models of the future.

Q: How can I keep up with new developments as the ACA is implemented?

Members can keep apprised of some of the most important ACA-related developments for the profession by monitoring the Advocacy Highlights section of AOTA’s Web site. AOTA maintains additional information on the Health Care Reform Implementation section of our Web site. We also encourage members to get involved in the advocacy opportunities that exist at the state level by contacting their state OT associations. For those interested in general developments related to ACA implementation, the Kaiser Family Foundation is a highly credible resource.

Dan Brown is AOTA’s senior state policy analyst.