Nine policies affecting occupational therapy may see end-of-year Congressional action
While the country watches what will happen during the elections taking place on November 8, 2022, AOTA Federal Affairs is preparing for what will happen after those elections—the final 6 weeks the 117th Congress. Two years of our advocacy work will come to an end in these final weeks when some policies will be signed into law, and others will have to start over again with the new Congress in January 2023.
When Congress comes back into session after the election, they will pass several large pieces of legislation to finish their work. Beyond two “must pass” bills, there are other legislative issues that could be added to these bills or be included in a separate large catch-all bill—including mental health, telehealth, and Medicare policies. This year we have an unprecedented number of issues related to occupational therapy (OT) services under consideration for these end-of- year bills.
Mental and behavioral health:
Policy #1:
In August, the Occupational Therapy Mental Health Parity Act (S. 7412) was introduced in the Senate. This legislation would help expand access to occupational therapy services for mental and behavioral health disorders under Medicare and Medicaid. While Congress passed legislation in July that would improve mental health services through Medicaid, the Senate is still working on legislation to improve the mental health workforce and increase access to these services through Medicare. A discussion draft of this mental health workforce package includes the Medicare provisions of S. 7412.
Policy #2:
Congress also 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 version of this legislation included a technical fix that would allow occupational therapy doctoral programs to apply for Behavioral Health Workforce Training Grants— currently only master’s-level programs can apply. It is unclear whether Congress will pass further mental health legislation this year, but if it does, we are well positioned to have both provisions signed into law.
Learn more about Mental and Behavioral Health issues on our Advocacy Issues Page
Workforce diversity:
Policy #3:
Last year the Allied Health Workforce Diversity Act (AHWD) was reintroduced in both the House (H.R. 3320) and the Senate (S. 1679). This legislation would create the AHWD program to increase opportunities to train occupational therapy practitioners from underrepresented backgrounds. After hearing testimony about the bill from AOTA Board Member Victoria Garcia Wilburn last fall, the bill passed out of the House Energy and Commerce Committee unanimously, to await a vote by the full House. In September 2022, the Senate Health, Education, Labor, and Pensions (HELP) committee approved the PREVENT Pandemics Act. Included in the legislation is language to create the AHWD program. There are currently efforts by Senate champions to include the PREVENT Pandemics Act in an end-of-year bill, which would make this new diversity program for allied health a reality.
Learn more about Workforce Diversity issues on our Advocacy Issues Page
Occupational therapy assistants:
Policy #4:
In October 2022, the Stabilizing Medicare Access to Rehabilitation Therapy (SMART) Act was introduced to help mitigate the impact of Medicare Part B cuts to services provided by occupational therapy assistants (OTAs) and physical therapist assistants (PTAs). One of those polices would change supervision of OTAs and PTAs in private practice from “direct” supervision to “general” supervision, to increase staffing flexibility in these settings and recognize the expertise of therapy assistants. An independent report commissioned by a group representing therapy providers showed that this provision could save the government money, making the policy extremely attractive to policy makers.
Policy #5:
The second major policy in the SMART Act was an exemption from the 15% cut for OTA and PTA services provided in rural and medically underserved areas. An analysis of the data from the commissioned report shows that OTAs and PTAs provide a higher proportion of services in these areas than in others. A separate study commissioned by AOTA also showed that therapy staffing levels per resident minute were lower in these areas. We hope the savings from the supervision policy could pay for this targeted exemption from these cuts.
Learn more about OTA Payment issues on our Advocacy Issues Page
Physician fee schedule payments—Medicare Part B
Policy #6:
The Centers for Medicare & Medicaid Services’ (CMS) proposed 2023 Medicare Physician Fee Schedule (MPFS) included cuts to services provided by occupational therapy practitioners and dozens of other Medicare health care providers. The proposed 4.42% cut to the fee schedule’s conversion factor would be in addition to cuts to the fee schedule from 2020 and 2021. In mid-September 2022, the Supporting Medicare Providers Act (H.R. 8800), was introduced to stop the upcoming 4.42% cut and is being considered for end-of-year legislation.
Policy #7:
Unlike other Medicare payment systems, the MPFS does not receive an automatic inflationary increase each year. Given the dramatic increase in inflation over the last year, we are advocating with a coalition of health care providers for Congress to provide an inflationary increase to the MPFS in addition to stopping the pending decrease to payments. The MPFS often sets the standard for all other reimbursement rates. Medicaid and private insurance companies typically set payments based on the current MPFS rates, meaning cuts or increases here can filter out to all other payers.
Learn more about Medicare Part B issues on our Advocacy Issues Page
Telehealth:
Policy #8:
On March 10, 2022, Congress passed legislation that extended current Medicare telehealth waivers for 151 days beyond the expiration of the public health emergency (PHE). This includes a specific extension for occupational therapists and occupational therapy assistants to provide services via telehealth to Medicare beneficiaries. This legislation prevented an OT “telehealth cliff” from occurring for Medicare therapy services when the PHE expires. However, to ensure there is no lapse in the ability to provide these services, we hope to see Congress extend these waivers through the end of 2023 or 2024, to make sure there is time to review necessary data and to enact permanent policy changes.
Learn more about Telehealth issues on our Advocacy Issues Page
Lymphedema:
Policy #9:
The Centers for Medicare & Medicaid Services has recognized the importance of compression garments in lymphedema treatment but has never included compression supplies as a Medicare benefit. The Lymphedema Treatment Act (H.R. 3630) would provide Medicare coverage for prescribed lymphedema compression treatment items, helping to reduce the medical and functional challenges related to lymphedema. In July, this bill passed out of the House Energy and Commerce Committee and is well positioned to be included in an end-of-year package of bills.
Contact your legislators on H.R. 3630 on our Legislative Action Center
You can take action:
November will be our month of action to make sure these policies are signed into law. Each week, advocates will receive one email detailing the action of the week. Go to our Legislative Action Center to join our mailing list to hear more about each week’s action, or you can use our Legislative Action Center to write to your policy makers on these issues today. In the meantime, we will continue to keep you updated on these and other issues as the 117th Congress comes to a close.
An additional note about school-based advocacy efforts:
AOTA Federal Affairs is also working on issues related to occupational therapy in the school system, including Department of Education efforts to clarify the 504 process and services, and efforts related to Medicaid billing for both special education and general education services. However, as this work is with a federal agency, it is not affected by the change to a new Congress in January, so it will continue without disruption into the new year.