House Passes Health Care Reform Legislation: Includes Many Improvements for OT
The House of Representatives passed the Affordable Health Care for America Act by a very slim margin on Saturday November 7th. The bill was supported by 219 Democrats and just 1 Republican, Representative Cao (R-LA). The narrow victory included a public option within the newly proposed health insurance exchange laying the groundwork for a heated Senate debate on the topic. All the provisions AOTA had been advocating for were included in the bill.
AOTA won a major victory for occupational therapy this week as reform efforts on Capitol Hill continue to progress. The House Democratic leadership on October 29 released its bill—a blend of earlier House health care reform bills—and it includes a long-awaited, hard-fought provision pushed by AOTA to elevate the status of occupational therapy in home health.
This great victory for occupational therapy and AOTA comes after years of work to improve recognition of occupational therapy in the home health community.
The language in Section 1155 of the bill allows occupational therapy to conduct the initial assessment if occupational therapy is in the plan of care prescribed by the physician referring the patient to home health. AOTA is still working to assure similar language is in the Senate bill. For a full description of the bill, go to AOTA’s Legislative Action Center Health Care Reform Hub.
Need for Member Advocacy Continues!
AOTA is having a continual “virtual” Capitol Hill Day until health care reform is passed by both the House and Senate and sent to the President for signature. Continue to work to keep occupational therapy in the policy spotlight! Go to our Legislative Action Center for more details.
Previously, the health care debate on Capitol Hill took a great leap forward on October 13 with the passage by the Senate Finance Committee of the America’s Healthy Future Act. The Finance Committee was the last committee in either the House or Senate to act on health care reform. It is also the committee that worked the hardest to be bipartisan, though at the end all Democrats and only one Republican—Sen. Olympia Snowe (R-Maine)—voted for the final proposal.
Several key victories were achieved for occupational therapy during the two weeks of deliberation by the Committee.
AOTA and grassroots lobbying by you—the members—made all the difference to ensure that key provisions were included and harmful provisions were changed or deleted. Members and staff worked around the clock during the Finance Committee’s deliberations—gathering information, analyzing the impact of amendments on occupational therapy, and generating grassroots responses. AOTA’s Capitol Hill Day on October 5 and the education program directors’ Capitol Hill Day on October 8 were perfectly timed to send the message that occupational therapy is part of the health care solution.
The achievements of AOTA were significant and show the influence of AOTA in protecting and promoting the profession:
A 2-year extension of the exception process for the Medicare cap on outpatient occupational therapy was included in the bill (and in all other health care reform proposals) to allow beneficiaries access to needed and appropriate care.
Specifying rehabilitation and habilitation services in the list of benefits that would be covered by new insurance products was championed by AOTA, in our capacity as a leader in the Consortium for Citizens with Disabilities. While rehabilitation considered to be covered under “outpatient services” or other categories), AOTA successfully lobbied senators to voice concern about and urge specific inclusion of this language. AOTA has been given assurance that rehabilitation and habilitation will be specified when the bill goes to the Senate floor. All other health care reform proposals include this category of services in their language.
A direct access amendment was proposed allowing physical therapists in rural areas the opportunity to provide services to Medicare beneficiaries without a physician referral or order. AOTA worked successfully to modify the amendment through direct lobbying with the sponsor, grassroots and leadership lobbying by Association members, and calling on occupational therapy’s friends on the Committee. AOTA’s efforts focused on assuring that occupational therapy was included in any changes related to direct access that the Committee adopted. Ultimately, the Committee significantly narrowed the scope of the amendment, authorizing the Centers for Medicare & Medicaid Services (CMS) to conduct a study to determine if efficiencies are achieved when direct access is allowed for any outpatient services. This means a study could be done of physical therapy, occupational therapy, or any other service. AOTA’s position is that any change in physician referral requirements under Medicare should treat all therapy services equally to assure that beneficiaries have equivalent access to all the services they may need. Many Medicare beneficiaries receive both occupational and physical therapy services; that argument was successful in changing the amendment to be inclusive.
Changes to payment and credentialing of providers of orthotics and prosthetics were proposed to save money in Medicare. AOTA’s interpretation of the language showed that occupational therapy practitioners’ ability to provide services would be eliminated for certain practitioners after the year 2013. In addition, a new payment system was to be implemented that could have resulted in severe cuts to what Medicare pays occupational therapy practitioners for orthotics. AOTA spread the word to other affected parties, including the American Society of Hand Therapists and others, to get them to join in the effort to oppose this language. In the end, the proposal was deemed to be not politically feasible and was not introduced, owing to the influence of AOTA and the activism of our members in challenging it.
Occupational therapy’s role as part of the solution to many of the problems of the health care system was highlighted by participants in the Hill Days. Wearing buttons that heralded this message and distributing talking points that were evidence-based, OT advocates promoted how occupational therapy should be included—at least for specific populations—in case management, care coordination, prevention, primary care, and the medical home concept. See the talking points here.