21st Century Cures Signed Into Law; Contains Major Victories for Occupational Therapy

Today President Barack Obama signed the 21st Century Cures Act into law. The bill includes four provisions important to occupational therapy, including three of which have been part of AOTA’s major grassroots and advocacy efforts.

The main focus of 21st Century Cures is to streamline federal research and the drug and medical device review and approval process in order to help promote new, life-saving treatments and medical advances. It also increases funding at the National Institutes of Health (NIH) by $4.8 billion over the next 10 years. As Cures was considered “must pass” legislation, Congress included two other major sections of “must pass” legislative language in the bill. The first of these sections is designed to improve our nation’s mental health services, and the second makes a series of small tweaks to Medicare.

The major victories for occupational therapy include the inclusion of OT in mental health training grants, an increase in the stature of rehabilitation research at NIH, a 6-month delay in subjecting complex rehabilitation technology (CRT) wheelchair accessories to competitive bidding, and a new focus at NIH on supporting emerging scientists.

Mental and behavioral health education and training grants

Included in the portion of the bill to improve mental health services is an expansion of a current grant program that currently helps with recruitment and training of professionals in certain mental health professions. Among other changes, the new language would award grants to, “accredited institutions of higher education or accredited professional training programs that are establishing or expanding internships or other field placement programs in mental health”, including occupational therapy.

This language helps to promote occupational therapy’s role in mental and behavioral health in two ways. First, occupational therapy educational programs would be able to apply for and receive grants in order to provide or improve fieldwork placements in mental and behavioral health settings. (AOTA believes this language would apply to training programs for all occupational therapy practitioners and will advocate for this position as the statute is implemented).

Secondly, this language will include, in federal statute, occupational therapy within a list of other mental health professionals (while not explicitly defining it as a “mental health profession”). Inclusion in a list such as this is essential for our continued efforts to have occupational therapy reimbursed for mental health services at the state level, to be included in future mental and behavioral health programs, and to be recognized as mental health providers in all 50 states.

Improving medical rehabilitation research at NIH

This portion of the bill mirrors legislation (S. 800; H.R. 1631) introduced by Senators Mark Kirk (R-IL) and Michael Bennet (D-CO) and Congressmen Jim Langevin (D-RI) and Gregg Harper (R-MS) to improve, coordinate, and enhance medical rehabilitation research at NIH. The language builds upon the conclusions and recommendations of an NIH Blue Ribbon Panel on Medical Rehabilitation Research, which issued a comprehensive report in January 2013 that concluded that rehabilitation research is not thriving at NIH and that reforms are needed to assist people with injuries, illnesses, disabilities, and chronic conditions in order to maximize their health and their ability to function, live independently, and return to work if possible.

This language does this by:

• Focusing on creating greater links within NIH to help coordinate rehabilitation research across Institutes and Centers to streamline rehabilitation research priorities and maximize the current federal investment in this area of research
• Involving the Office of the NIH Director in coordination activities
• Updating the Rehabilitation Research Plan every 5 years following a scientific conference or workshop
• Requiring an annual progress report
• Tying co-funding of medical rehabilitation research projects to the Research Plan
• Including a definition of medical rehabilitation research to ensure consistent tracking of rehabilitation research across NIH.

We believe that this language will help to raise the stature of rehabilitation research at NIH and to help it thrive.

CRT wheelchair seating systems and accessories

Under current law, the seating systems and accessories used in conjunction with complex rehabilitation technology wheelchairs is subject to competitive-bidding pricing. Many fear that subjecting these items to competitive bidding will limit access, and make it more difficult for individuals to receive the system or accessory that is the most appropriate for that individual. Congress delayed implementation of competitive bidding for 1 year, but this delay expires at the end of 2016. The 21st Century Cures Act will extend this delay through July 2017. While AOTA supports a permanent fix to this flawed policy, we are pleased that this 6-month extension was included.

Supporting young emerging scientists

Finally, a portion of the bill titled, “Supporting Young Emerging Scientists” would help to ensure that the next generation of health research scientists is nurtured, provided with opportunity, and allowed independence earlier than is currently the case.

Similar to the rehabilitation research provision, the bill would establish the “Next Generation of Researchers Initiative” within the Office of the Director of NIH. This would help to ensure a coordinated effort, across NIH, to promote and develop policies and programs that are focused on improving opportunities for new researchers, promoting earlier research independence to increase opportunities for new researchers to receive funding; enhancing training and mentorship programs for researchers; and enhancing workforce diversity.

Additionally, this section will expand the existing loan repayment programs at NIH. The program will be divided into intramural research and extramural research and provides loan repayment for researchers engaged in specific types of research. The new extramural loan repayment program includes pediatric research, minority health disparities research, clinical research, and clinical research conducted by an appropriately qualified health professional who are from disadvantaged backgrounds. We anticipate that some occupational therapy research scientists would be eligible for this program and will carefully monitor the program as it is implemented.

AOTA is extremely pleased to see these hard-fought provisions included in the final legislation.