Advocacy issues

Since its beginnings, occupational therapy has promoted mental health through engagement in meaningful occupations. As service delivery and payment models have evolved, the profession has seen fewer opportunities to provide services to those with behavioral health challenges. AOTA is working to increase access to occupational therapy services for people with serious mental illness, substance use disorder, and other behavioral health needs.

AOTA is working to ensure that occupational therapy is valued and protected in the health insurance marketplaces created by the Affordable Care Act (ACA).

Medicaid is a state–federal partnership that provides health care to people of all ages—children, pregnant people, working-age adults, individuals with disabilities, and people over age 65. Occupational therapy practitioners work with people who rely on Medicaid for health care across multiple settings, including schools, community mental health centers, skilled nursing facilities, and clients' homes.

Learn about AOTA’s legislative and regulatory advocacy for occupational therapy services provided under the Medicare Part B fee schedule, including the latest on how AOTA is fighting against Medicare cuts to therapy services.

The Medicare Occupational Therapy Assistant (OTA) 15% payment differential is set to take effect on January 1, 2022. We have been advocating to protect occupational therapy assistants and to preserve access to occupational therapy services in light of this new payment policy. Learn more about our legislative and regulatory advocacy to educate policymakers and minimize the impact of the 15% payment differential, including our recent grassroots advocacy campaigns with Congress and the Centers for Medicare & Medicaid Services (CMS).

The Occupational Therapy Licensure Compact (OT Compact) is a joint initiative of the American Occupational Therapy Association (AOTA) and the National Board for Certification in Occupational Therapy (NBCOT®). The OT Compact is an interstate professional licensing compact for occupational therapy which will address licensure portability. This is a multi-year initiative which requires legislation to be passed in each state where the OT Compact will apply.

Payment policies for post-acute care services, including occupational therapy services, are ever-evolving. Learn about AOTA’s legislative and regulatory advocacy activities to promote and protect quality therapy services, reimbursement and the role of occupational therapy practitioners working in post-acute care settings, including skilled nursing facilities, home health agencies and inpatient rehabilitation facilities.

Several sources of public and private payment exist for occupational therapy services. Medicare is the single largest insurer in the United States, however, understanding the payer policies for Medicare Advantage (i.e., managed care), and other forms of private health insurance coverage is also critical to occupational therapy practitioners. Learn more about AOTA’s multifaceted advocacy efforts to advance payment for occupational therapy by private insurers.

Primary education and early intervention services are largely controlled by state and local governments. However the federal government has some influence over these programs through federal laws such as the Individuals with Disabilities in Education Act (IDEA) and the Every Student Succeeds Act (ESSA). The AOTA policy team works at both the state and federal levels to protect and promote the role of occupational therapy in both of these settings.

An occupational therapist's or occupational therapy assistant's scope of practice is defined in state law and describes the services that the occupational therapist or occupational therapy assistant is deemed competent and permitted to perform. AOTA's advocacy efforts in this area include advocating for legislation to update state practice acts and reviewing legislation related to other profession's practice act revisions and new licensure of professions to ensure there is no infringement on the occupational therapy scope of practice.

The delivery of occupational therapy (OT) services via telehealth expanded exponentially when the COVID-19 pandemic threatened access to services in 2020. State Medicaid plans, private insurance, and Congress reacted quickly by allowing patients to temporarily receive OT services via telehealth. However, much of this expansion will end when waivers enacted by Congress end. AOTA is working to ensure that this expansion becomes permanent.

Data shows that increasing the diversity of the health care workforce will lead to improved access to care, greater patient choice and satisfaction, and better education experience for health professional students. AOTA has been advocating for federal policies that will help improve the diversity of the occupational therapy workforce by increasing the number of practitioners from backgrounds currently underrepresented within the profession.