Occupational Therapy Mental Health Parity Act Introduced in Senate

Legislation removes barriers to people with a behavioral health disorder receiving occupational therapy services under Medicare, Medicaid.

FOR IMMEDIATE RELEASE: Washington, DC (August 24, 2022) — U.S. Senators Maggie Hassan (D-NH) and Tim Scott (R-SC) introduced the Occupational Therapy Mental Health Parity Act (S. 4712) in order to expand access to occupational therapy services for mental and behavioral health disorders under Medicare and Medicaid.

AOTA President Alyson Stover, MOT, JD, OTR/L, BCP said, “This legislation executes a vision in which occupational therapy is a typical member of behavioral health and mental health interdisciplinary teams. It also creates an opportunity to emphasize the value benefit of occupational therapy beyond addressing only physical health needs. We can prove that including spending for occupational therapy in mental health settings will improve patient outcomes for those with mental health diagnoses and behavioral health impairments in the same way it has been proven to do so for those with heart failure, pneumonia, and acute myocardial infarction¹.”

The key outcome of occupational therapy services is to help a person maintain or regain their functional capabilities—those skills they need to function independently every day, regardless of an individual’s diagnosis, or what is causing challenges with day-to-day function. Under Medicare and Medicaid, occupational therapy services can be provided to a person who has a mental health or substance use diagnosis if the disorder causes challenges with daily function.

In the United States, occupational therapy practitioners often face challenges providing, and billing for, services that do not address physically related performance deficits. This has led to occupational therapy practitioners being an untapped part of the behavioral health workforce. While today, occupational therapy practitioners provide services in some community settings such as Community Mental Health Centers (CMHCs), Certified Community Behavioral Health Clinics (CCBHCs), Medicare Partial Hospital Programs (PHPs), assertiveness community treatment (ACT) teams, psychosocial clubhouse, homeless and women's shelters, and correctional facilities, their presence in these settings is not guaranteed.

The Occupational Therapy Mental Health Parity Act seeks to remove barriers to the provision of occupational therapy services for someone with a mental health diagnosis under Medicare and Medicaid—where these services are an allowed, but under-recognized benefit. This, in turn, would help Medicare and Medicaid recipients more readily access occupational therapy services for behavioral health challenges impacting functional skills, and help address the current shortage of behavioral health professionals.

“Occupational therapists can play a key role in helping patients with mental health and substance use disorders,” said Senator Hassan. “This bipartisan bill would clarify that Medicare and Medicaid can provide for occupational therapy for mental health and substance use disorders. I encourage my colleagues to support this commonsense bill.” 

Senator Scott said, “With the recent rise in substance abuse and mental health crises across the nation, it’s crucial that we get Americans the help they need. As ranking member of the Senate Committee on Aging, I’m especially glad that this bill could break down barriers to treatment for millions of Medicare beneficiaries, and I urge my colleagues to join me in this bipartisan effort.”

Services Under Medicare

Occupational therapy is a standard rehabilitation service provided under Medicare to seniors in a wide array of outpatient rehabilitation settings, including Skilled Nursing Facilities (SNFs). The Centers for Medicare & Medicaid Services (CMS) clearly authorizes the provision of occupational therapy services to Medicare recipients with a psychiatric disorder. Additionally, occupational therapy is a required component of Medicare partial hospitalization services both under statute and as a part of the conditions of participation. Notwithstanding this clear statement of CMS coverage there remains a lack of understanding of the role of occupational therapy in providing these services in more traditional settings. For example, in a SNF, occupational therapy practitioners can help increase functional performance and engagement in meaningful activities. 

This legislation requires the Secretary of the Department of Health and Human Services (HHS) to provide education and outreach to stakeholders about the provision of occupational therapy services to a person with a mental health or substance use disorder under Medicare.

Services Under Medicaid

Coverage under Medicaid for occupational therapy services for a person with a mental health or substance use disorder is a complicated patchwork of policies and assumptions that varies greatly from state to state. CMS guidance would help clarify to states and state plans the role of occupational therapy in providing mental health and substance use disorder services. It would highlight how these services are an avenue to help meet the mental and behavioral health needs of their state, within an existing Medicaid benefit. This is particularly crucial as states embark on developing robust, community-based mental health services under the recent expansion of Certified Community Behavioral Health Centers.

This legislation requires the Secretary of the Department of Health and Human Services (HHS) to issue guidance to states that occupational therapy can be provided under Medicaid to a person with a mental health or substance use disorder, ending the current confusion on this issue.

Increasing the Behavioral Health Workforce

Even before the pandemic, nearly one in five Americans had been diagnosed with a mental illness and more than 20 million had a substance use disorder. At the same time, there is a documented shortage of mental health professionals, with at least 152 million Americans living in a mental health professional shortage area. Despite this need, occupational therapy practitioners remain an untapped part of the behavioral health workforce, especially in community-based settings. 

Nationwide, more than 233,000 occupational therapy practitioners help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Legislation supporting access to occupational therapy and rehabilitation services can reduce overall health care costs by facilitating independence among patients.     

¹Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2017). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 6, 668–686. https://doi.org/10.1177/1077558716666981

Founded in 1917, the American Occupational Therapy Association (AOTA) represents the professional interests and concerns of more than 230,000 occupational therapists, assistants, and students nationwide. Occupational therapy practitioners facilitate participation in everyday living for people of all ages. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations, and serving as an advocate to improve health care. Based in North Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, visit www.aota.org.

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To interview a representative from AOTA on this topic, contact AOTA's Communications Team, praota@aota.org.