End of year legislation includes new mental health benefit, advances occupational therapy
When Congress unveiled a massive $1.7 trillion omnibus legislative package, it included multiple provisions to strengthen mental health services. One provision created a new Medicare mental health benefit: intensive outpatient services to be provided at federally qualified health centers (FQHCs) or rural health clinics. This new benefit could significantly increase the ability of occupational therapy practitioners to provide community mental health services.
Currently under Medicare, there is a "partial hospitalization" mental health benefit for beneficiaries who require 20 hours a week of mental health services, provided in an outpatient setting. Occupational therapy is a listed service in the partial hospitalization law, and regulations require that anyone receiving partial hospitalization services be evaluated to determine whether they need occupational therapy services, and if so, that they receive them.
The new intensive outpatient benefit mirrors the partial hospitalization benefit, although it would apply for an individual who only needs 9 hours of services per week (compared to 20) to qualify. All of the mental health services included in the benefit, such as occupational therapy, remain the same. FQHCs are traditionally paid using a pre-established bundled rate; however, the intensive outpatient services will be paid separately at the same rate as if they had been provided at a hospital outpatient department.
The Centers for Medicare & Medicaid Services must now develop regulations governing intensive outpatient services. AOTA will monitor tis process closely and advocate for the regulations to be the same as those governing partial hospitalization, i.e. requiring occupational therapy services. We will also continue to analyze this new benefit and believe that it provides an exciting new opportunity to provide occupational therapy mental health services in the community, and an exciting opportunity to work in FQHCs and rural health clinics.
OTD programs now eligible to apply for the BHWET Grant Program
Throughout this year, Congress has been working on legislation to renew key mental and behavioral health programs at the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). The House legislation renewing these programs included a technical fix that would allow occupational therapy doctoral programs to apply for Behavioral Health Workforce Education Training BHWET) Grants administered by HRSA. Previously only master’s-level programs could apply. In 2015, occupational therapy education programs were made newly eligible for this grant program, but HRSA’s interpretation of the law lead them to only allow master’s-level programs to apply. The omnibus included the House-passed technical fix that will allow doctoral-level programs to apply in the next grant cycle. BHWET grants provide academic programs with funding to help train mental health professionals, including funding to support fieldwork opportunities in mental and behavioral health settings.
You can follow our work in the new Congress on these and other issues on the Advocacy section of the AOTA website, and can write to the new Congress by going to the AOTA Legislative Action Center. You can also check out AOTA’s mental health resources.