AOTA Advocating for You — 2021 in Review

Here are some of our successes in 2021 and where work continues:

Home Health Services: At the end of 2020, Congress passed legislation allowing occupational therapists to permanently open home health cases for physical therapy, speech language pathology, and occupational therapy cases. The goal of this legislation was to raise the profile of occupational therapy in home health and increase opportunities in this setting. In November, 2021, the Centers for Medicare and Medicaid Services (CMS) finalized the rule for this change, officially making it a permanent part of home health services.

Schools and Early Intervention: At the beginning of 2021, COVID was still causing major disruption to the provision of pediatric services, so AOTA led the effort to secure COVID funding specifically for the Individuals with Disabilities Education (IDEA) Act to address the challenges the COVID-19 public health emergency presented for students with disabilities. It was especially important to secure supplemental funding for early intervention services, as Congress failed to provide any additional funding during the pandemic to support efforts to help children from birth to 5 with a disability or those at risk for a developmental delay. When Congress passed the American Rescue Plan (ARPA), AOTA was thrilled to see $3 billion in supplemental funding for the IDEA, including nearly half a billion dollars for early intervention services. 

Home- and Community-Based Services: The COVID-19 pandemic brought attention to the crucial issues of improving home- and community-based services for adults with disabilities. Significant money was provided in ARPA to improve these services through State Medicaid agencies. In addition to these actions, Congress spent the year trying to develop a long-term path forward to help make community-based services the norm, and not the exception. AOTA worked with Congressional champions to help shape future legislation to improve these services.  

Older Adults Home Modification Program (OAHMP) through the Department of Housing and Urban Development (HUD): In March, HUD released a long-awaited funding opportunity for the provision of “low-cost, low-barrier, high impact home modifications” to allow homeowners to better age in place. OAHMP specifically requires the involvement of a licensed occupational therapist or supervised occupational therapy assistant to ensure the modifications utilize a person-centered approach that improves the home owner’s ability to function safely within their home. In August, HUD award 32 grants to community organizations, including AOTA partner organizations. This program was first funded by Congress in 2018 after AOTA advocacy efforts.

Medicare Reimbursement Challenges: Due to changes to the Medicare Physician Fee Schedule and Congressional budgeting requirements, OT services under Medicare Part B were facing a 9.75% cut in 2022 and Part A services were facing a 6% cut. AOTA fought alongside a powerful coalition of health care providers to prevent these cuts. Thanks to persistent advocacy, Congress reduced and phased in these cuts. In January there will be no reduction to Part A services but there will be a phase in to a 2% reduction by July 2022. Similarly, OT services under Part B will reduced by 0.75% in January, phasing into a 2.75% reduction by July. AOTA continues to work with our coalition partners to pressure Congress to make changes to the budgeting gimmicks that are responsible for 6% of these reductions and to address issues with the Medicare Physician Fee Schedule that are responsible for the arbitrary 2.75% reduction to Part B OT services. 

Supporting Occupational Therapy Assistants: Congressional champions introduced the Stabilizing Medicare Access to Rehabilitation and Therapy “SMART” Act (H.R. 5536) to reduce the impact of a 15% reduction to occupational therapy assistant services under Medicare Part B, beginning in 2022. The bill would help to reduce this impact by delaying the cuts until 2023, permanently exempting rural and underserved areas from the reductions, and reducing overly restrictive Medicare supervision requirements in private practice settings.

Allied Health Workforce Diversity: The Allied Health Workforce Diversity Act (H.R. 3320/S. 1679) was once again introduced in the new Congress. This bill would help increase opportunities to train occupational therapy practitioners from underrepresented backgrounds. The House Energy and Commerce Subcommittee on Health passed the Allied Health Workforce Diversity Act, after AOTA Board Member Victoria Garcia Wilburn testified before the subcommittee on the bill. The bill should be voted on early next year in the House of Representatives and will then move on to the Senate for consideration.

Behavioral Health: COVID-19 highlighted the continuing need to improve behavioral health services. In 2021, four different pieces of legislation related to behavioral health were introduced that included occupational therapy, including:

• The Primary and Behavioral Health Care Access Act (HR 3550)
• The Mental Health Professionals Workforce Shortage Loan Repayment Act (H.R. 3150/ S. 1578)
• The Mental Health Workforce and Language Access Act (H.R. 5937)
• The HEALTH for Mom Act (S. 1622).

Additionally, the House Energy and Commerce Committee recognized the value of OT in behavioral health by fixing an issue where only master’s-level programs could apply for Behavioral Health Education Workforce Training Grants. The new legislative language would allow OTD programs to apply for funding through this program as well. 

Medicare Telehealth: Legislation to permanently allow occupational therapy services to be provided via telehealth under Medicare, the Expanded Telehealth Access Act, was re-introduced in the House of Representatives in March and introduced for the first time in the Senate this November, marking an important gain of Senate support for the legislation. Congress has introduced multiple bills to either extend many of the COVID-19 telehealth waivers, or make them permanent, including the Telehealth Extension Act (H.R. 6202) which would extend the ability of occupational therapy practitioners to provide Medicare services by telehealth for 2 years after the end of the public health emergency, and the Telehealth Modernization Act, which would give the Secretary of Health and Human Services the authority to permanently add OT telehealth services under Medicare.