Occupational Therapy Mental Health Parity Act introduced in Senate
On August 2, 2022, U.S. Senators Maggie Hassan (D-NH) and Tim Scott (R-SC) introduced the Occupational Therapy Mental Health Parity Act (S. 4712). This bill expands access to occupational therapy services for mental and behavioral health disorders under Medicare and Medicaid.
AOTA President Alyson Stover, MOT, JD, OTR/L, BCP stated, “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 infarction (Rogers et al., 2017).”
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. Although today we provide services in 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 clubhouses, homeless and women's shelters, and correctional facilities, our presence in these settings is not guaranteed.
This legislation 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.
Services Under Medicare
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, including improving functional performance and decreasing distressed behaviors.
This legislation requires the Secretary of the Department of Health and Human Services 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 the role of occupational therapy in providing mental health and substance use disorder services to states and state plans. 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 $8.6 billion investment and expansion of Certified Community Behavioral Health Centers and implementation of new mental health crisis 9-8-8 services.
This legislation requires the Secretary of the Department of Health and Human Services 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 and face particular challenges providing these services. The Occupational Therapy in Mental Health Parity Act will help make occupational therapy professionals a typical member of the mental and behavioral health team.
Reference
Rogers, 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.