Aetna eliminates physician signature requirement for OT

The American Occupational Therapy Association (AOTA) successfully advocated for a change to Aetna's occupational therapy policy that removes the requirement for a physician's signature on occupational therapy (OT) plans of care. Effective May 20, 2026, this change reduces administrative burden, supports timely access to services, and recognizes the professional autonomy of occupational therapy practitioners (OTPs).

For many years, physician signature requirements have created delays in starting or continuing therapy, increased paperwork, and added complexity to care coordination. AOTA spent considerable time engaging on this issue, emphasizing to Aetna how these requirements could negatively affect patient care and create unnecessary inefficiencies.

AOTA also emphasized occupational therapy's established standards for independent practice. In the updated policy, Aetna included language, citing AOTA’s Standards of Practice and Model Occupational Therapy Practice Act, that emphasizes the ability of OTPs to practice independently without direction from other health service providers while also highlighting that referrals and/or collaboration between OTPs and other multidisciplinary providers remain essential for patients with functional limitations in daily activities.

The inclusion of this language highlights the rationale for removing the physician signature requirement. It affirms that OT practitioners are qualified to evaluate patients, develop plans of care, and provide treatment within their scope of practice while continuing to recognize the importance of interdisciplinary collaboration when appropriate.

Aetna’s policy update reflects the increasing focus on reducing unnecessary administrative requirements, improving access to care, and recognizing clinician expertise. For patients, this change helps ensure that care delivery is focused on clinical need and professional judgment rather than unnecessary administrative requirements. For practitioners, this change means less time chasing down signatures and more time spent supporting individuals, families, and communities to fully participate in daily life.

This policy change reflects the impact of AOTA’s advocacy efforts that emphasize evidence-based engagement with payers to advance policies that support occupational therapy practice, reduce administrative burden, and improve access to care.

AOTA remains committed to working with payers, policymakers, and others to remove barriers to care, advance the profession, and improve access to occupational therapy services nationwide.

Please contact AOTA at Regulatory@aota.org with any questions.

Resources

• Aetna Clinical Policy Bulletin # 0250: Occupational Therapy
• AOTA: Standards of Practice for Occupational Therapy (2021)
• AOTA: Model Occupational Therapy Practice Act (2022)