Clarice Grote, MS, OTR/L

Clarice Grote, MS, OTR/L

End of Year 2022 Legislative Updates its impact on OT

The 117th Congress recently passed the $1.7 trillion Omnibus Budget Reconciliation Act of 2023 AKA “the omnibus bill.” But what does that mean for occupational therapy?

If you need a quick refresher on how Medicare law is made, check out this podcast or article before we dive in.

Policies Discussed in this Article:

Allied Health Workforce Diversity Program

A huge win for OT! This program, like the name implies, supports efforts for a more diverse and representative healthcare profession by providing grant funding to accredited higher education healthcare programs to support their efforts to increase opportunities for diverse students. This means that accredited OT schools have an opportunity for additional funding to attract, recruit, and retain students from underrepresented and disadvantaged backgrounds. Check out the resources in this article to learn more.

Extension of Medicare Telehealth Waivers

This successful advocacy effort for OT extends Medicare Telehealth waivers through the end of 2024. This means that both occupational therapists and occupational therapy assistants can be reimbursed for telehealth services for Medicare beneficiaries for 2023 and 2024, regardless of the status of the COVID-19 Public Health Emergency. Before the Public Health Emergency, occupational therapy practitioners were unable to be reimbursed by Medicare for services provided via telehealth. This changed with the declaration of the COVID-19 Public Health Emergency, and now telehealth services provided by occupational therapy practitioners will be reimbursed for Medicare recipients through the end of 2024.

While a permanent solution is still needed, this buys practitioners and companies time to continue to provide these important services. Stay tuned for future legislation to be introduced to propose a permanent fix.

Medicare to Cover Compression Garments for Lymphedema

A win for occupational therapists who treat patients with Lymphedema! The Omnibus bill finally included the Lymphedema Treatment Act. This provision ensures that Medicare beneficiaries are covered for the supplies needed to manage their edema as a result of Lymphedema.

Medicare currently covers occupational therapy services for lymphedema interventions, but it does not currently cover many supplies that are essential for treatment and maintenance of the disease. These supplies include garments and other frequently prescribed items. This law does not immediately go into effect as it still needs to undergo a rule-making process. If I were to guess, we won’t see any official change in policy until 2024. Keep an eye on any proposed rules this summer. To get updates on this policy, be sure to sign up here to receive updates from Amplify OT.

Expansion of Intensive Outpatient Mental Health Services Covered by Medicare

More great news for the profession. This provision created a new Medicare mental health benefit for intensive mental health outpatient services be provided at federally qualified health centers (FQHCs) and rural health clinics. With this program, occupational therapists have an opportunity to get paid by Medicare for community mental health services through these agencies. While FQHC’s are paid using a bundled-payment model, the intensive outpatient services will be paid separately. More regulations from CMS will come on this, and we will watch closely for updates.

OTD Programs can Apply for BHWET Grants

Another win for OT’s role in mental health allows OTD programs apply for Behavioral Health Workforce Education Training (BHWET) Grants, where previously only master’s level programs were able to apply.

Medicare Part B Payments – Medicare Physician Fee Schedule

Unfortunately, this legislation did not completely remove the cuts seen from the 2023 Medicare Physician Fee Schedule, which proposed a 4.5% reduction to Medicare Part B reimbursement for services from occupational therapy practitioners. However, the omnibus reduced the size of the payment cuts for 2023 from 4.5% to 2% (a win but a disappointing win). In addition to the proposed 4.5% MPFS cut, occupational therapists and all Medicare providers were facing another 4% cut known as PAYGO. PAYGO was waived with the omnibus, preventing an additional 4% reimbursement cut for occupational therapists.

So, bad news is occupational therapists will be receive a payment cut of 2% from services provided to Medicare Part B beneficiaries in 2023, but that is better than the originally proposed 8.5% cuts. Check out this article and this podcast for more information on the process of Medicare Part B cuts.

Occupational Therapy Assistants

The SMART Act was introduced to reduce the effects of the Medicare Part B cuts to reimbursement for services provided by occupational therapy assistants. We had hopes that the supervision provision would pass which would permanently allow OTAs to receive general supervision in private practice instead of direct supervision. When AOTA comissioned a study, the study found that changing supervision requirements would save money. However the Congressional Budget Office disagreed. The CBO saw it as a cost so instead of the change saving money, they felt it would increase the cost of the bill so it was left out.

AOTA plans to reintroduce elements of this this bill such as the exemptions to FQHCs and rural clinics and the supervision requirements in the 118th Congress. The advocacy efforts are not over!

Potential Opportunities For OT

This was a HUGE piece of legislation with over 4,000 pages. AOTA is combing through it diligently to find more potential opportunities for OT. Here is some of what they’ve seen so far:

  • Transparency requirements in payments for Home Health from CMS calculations under PDGM and services from home health agencies.
  • Increased funding for 988 suicide prevention helpline program and mental health crisis services .
  • A focus on maternal health and maternal mental health.
  • Increased funding for general and special education
  • and who knows what else!

Now What Can I Do?

Policy has a major impact on the every day practice of occupation therapy. Which is why it’s so important to stay aware of what’s going on! But when you’re a busy practitioner, that can be challenging. Here’s some easy action items to make staying informed easy for you!.

Ready to stop guessing and learn how Medicare actually impacts and pays for OT?? Click here to register for Mastering OT Policy and Medicare.

Resources and Additional Information

Clarice standing in a light room smiling wearing black pants and a light green puff sleeve shirt

hi there,

I’m  Clarice

Occupational therapist & medicare specialist helping practitioners understand policy, engage in advocacy, and own their value!

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