A lot is going on with occupational therapy advocacy and policy initiatives every day. A majority of that work is being done by AOTA, volunteers, and state associations. If you aren’t an AOTA Member yet, I encourage you to become one at aota.org/join. If you are, thank you!
**When it comes to policy, things change quickly, and information may have changed by the time you read this.
Send me your advocacy updates to be considered for this article!
September 2023 OT Advocacy & Policy Updates
Minimum Staffing Requirements
HHS has proposed minimum staffing standards for nursing homes. This proposal is in alignment with initiatives from the White House to support quality care improvements. Therapy practitioners are not included in the minimum staffing requirements and these new proposed rules have already met significant resistance. Comments are due on the proposed rule by November 6th.
See the Press Release Here
July 2023 OT Advocacy & Policy Updates
New Home Health Proposed Rule Signals Reimbursement Reductions
As our hot policy summer is heating up, CMS released another proposed rule – this time for home health!
Unfortunately… home health agencies are once again faced with fighting some cuts in funding. CMS is proposing this change due to what they call “behavior adjustments” after the implementation of PDGM.
Here’s what you need to know:
- Cuts and increases add up to a ~2.2% overall cut in reimbursement (around -$375 mil for 2024)
- Adjustments are made for several reasons, however the primary reason is due to behavior changes after PDGM implementation.
- Proposed removal of M2200 – Therapy needs items & M0100 – Episode Timing from the OASIS
- Updates to calculations for PDGM, LUPAs, etc
- New Benefit: Adding coverage for compression garments after the passage of the Lymphedema Treatment Act
- Proposed removal of the current measure “Application of Percent of LTCH patients with an Admission and Discharge Functional Assessment and a Care Plan That Address Function” and replacing it with a Discharge Function score.
- This is consistent with other post-acute care rules
- This is also proposed to replace the Self-care and Mobility composite score quality measures used for value-based purchasing.
- Adding COVID-19 Vaccine as a quality measure along with Transfer of Health Information to Patient/Provider
In regards to the cuts, the National Association for Home Care & Hospice (NAHC) is suing CMS over the proposed payment rate cuts due to allegations of an “invalid” methodology used to determine the payment cuts. Read more about that lawsuit HERE
I think there are some pros to the removal of “M2200 – Therapy Need” because, at times, this is being filled out without consultation with therapists. However, is there an opportunity here to advocate for an added item that tracks how much therapy is provided on the D/C OASIS like what the MDS has? What safeguards are in place to ensure patients receive adequate care?
With these changes, it is all the more important to ensure we are highlighting the value of occupational therapy in home health.
SNF and IRF proposed rules have both closed for comment, and their policies will be implemented on October 1, 2023.
Key changes include:
- Removing Section G from the MDS
- Implementation of the Transfer of Health Information quality measures in SNF
- Implementation of health equity items on MDS
- Proposed changes to the quality reporting program for FY 2025
- Requested comments on minimum staffing requirements
- How therapy fits into this is still something being considered and discussed – pros and cons to being included in direct staffing hours
- We want to be acknowledged as a valuable staff member of the care team, but we also don’t want to be confused for aide services or direct care especially given high productivity demands in SNFs. How do we recognize value of therapy without blurring lines between unskilled services provided by therapy providers and skilled therapy intervention?
Draft updates are published for the MDS and the IRF-PAI on CMS’s website. Final rules should be published in the next month.
June 2023 OT Advocacy & Policy Updates
Workforce Meetups Hosted by AOTA
Let’s be honest. The occupational therapy workforce is in trouble. Burnout rates are high, moral is low, and feeling satisfaction at work has become a challenge for many of our practitioners. So what can we do? Well, to help address these concerns and develop action plans, AOTA is starting monthly meetings to hear from YOU!
Description from AOTA: This new monthly virtual event is a way to engage our workforce and community partners while focusing on innovative practice and workforce trends that impact the profession. Recognizing that our profession is evolving, and individual practice areas may be in a state of transition, we need support from our members and partners to propel our workforce toward the future.
Attendance is free and you do not have to be an AOTA Member to attend. You just have to register in advance here.
May 2023 OT Advocacy & Policy Updates
AOTA Call for Papers
It’s already time to start thinking about next year’s AOTA Inspire in Orlando, FL! I acknowledge some of the difficult feelings folks may have around the location. However, I will say I am excited to go and look forward to visiting Disney World for the first time since I was a kid! (I hope to see you there)
Call for Papers for INSPIRE are NOW OPEN through June 13th at 11:50 pm PST. Submit your proposal here.
If you’re interested in submitting a proposal to INSPIRE (which you should), I’ll be sending out a link to my free training on the process soon. If you’re an Amplify OT Member, then you can access it HERE today!
Congrats to Dr. Razan Hamed for being elected to AOTA Board of Directors (P.S. Razan is a member of the Amplify OT Membership Community). Elections are always a sobering reminder of how few members vote. Only 1600 AOTA Members voted in this special election.
Only 63 members voted in Colorado, which means they didn’t reach quorum (100 members) for the Representative Assembly, so the position will be appointed by the VLDC.
There were numerous notifications sent out by AOTA primarily through email, so if you didn’t get those, make sure to check your spam so you don’t miss ’em next time. Make your voice heard by voting!
Coding Update for Assitive Tech and Wheelchairs
AOTA published a new article on updates and clarifications for billing 97755 and 97542 after AOTA joined APTA in asking for clarification on these codes in 2019.
This article clarifies when to bill each code based on the services that are provided. Accurate coding is essential for billing and also for data collection, so if you bill these codes, check out the article here!
Documentation Series from AOTA – Audit Proof Your Documentation
AOTA has been hosting a 4-part documentation series that has been 🔥. Their most recent session was on May 9th on how to audit-proof your documentation which is a must, especially if you’re in private practice.
Documentation is about so much more than just billing, so be sure to check out this series to protect yourself and your patients!
My Article in May’s OT Practice: New OASIS in Home Health Brings Opportunites for OT
Check out my latest contribution to OT Practice all about the OASIS E, value-based purchasing, and other updates to home health for 2023! Read it here or in your OT Practice Magazine.
Capitol Report: Certified Community Behavioral Health Clinic Expanded Nationwide!
CCBHCs have been around since 2015, and thanks to strong advocacy from AOTA, occupational therapy practitioners were included as eligible clinicians under this funding. CCBHCs use federal funding “to provide comprehensive mental health and substance use services.”
It was initially tested in 8 states and is now being expanded nationwide! Additionally, states who apply for funding will list what staff they require as part of the certification, which means each state can now advocate for OT to be REQUIRED staffing.
Bring this to your state association to see how you might be able to optimize on this opportunity!
March 2023 OT Advocacy & Policy Updates
AOTA Compensation & Workforce Survey
Every year, AOTA polls all OTs and OTAs for information on their compensation and positions. The aggregate results are published in an interactive form to AOTA’s website and can be used to compare pay and benefits across settings, experience, and location. AOTA and individual practitioners use the results for salary and benefit advocacy and to develop career and practice resources.
It is critical that as many OTs and OTAs as possible participate in the survey. More participants mean better data. The survey takes fewer than 10 minutes to complete and is completely anonymous. After the survey, there is an option to put in contact info (not linked to the survey) for a chance to win a prize!
Expanded Home Health Value-Based Purchasing (HHVBP) Model Survey
CMS is putting out a survey for anyone actively involved in your home health agency’s expanded HHVBP Model efforts to learn more about your home health agency’s experience with resources provided for the expanded HHVBP Model and identify areas for future outreach and education. The survey should take no longer than 10 minutes to complete. The last day to take this survey is March 31st.
Medicare Home Health Prospective Payment System CY 2023 Webinar
CMS experts provide an overview of several provisions from the CY 2023 Home Health Prospective Payment System. Some topics that will be covered include behavior changes, the construction of 60-day episodes, and the payment rate development. Register here!
State Regulation Opportunities
AOTA put out an article highlighting some of the main occupational therapy state advocacy topics during this legislative period.
The Occupational Therapy Licensure Compact is continuing to move forward. We expect at least 15 more states to consider the compact during the 2023 legislative session. To learn more about the progress the other 22 states have made, check out the OT Compact website.
State Regulations of Occupational Therapy may also be discussed in the form of licensure board reform. Some states have proposed consolidating different professions’ licensure boards and moving the boards from one department to another.
Occupational Therapy Scope of Practice may be up for debate in states as AOTA recently revised the Occupational Therapy Model Practice Act. Things that may be included in these discussions include language to define OT’s role in mental health, the ability to deliver services via telehealth, how OT works with modalities, and direct access for OT. OTs can work with state Medicaid agencies to make sure they can be considered mental health providers.
With the end of the COVID-19 pandemic, many states will be re-evaluating their Telehealth policies. Some policies will be reconsidered during the 2023 legislative session, including expanding services offered via telehealth and providers who may provide these services, payment parities, ensuring quality of care, cross-state licensing, and clarifying what services can be provided.
AOTA Board of Directors Position Open for Nomination
Do you want to have an influence on the direction of AOTA? Have a voice in influencing the future of the profession? Then nominate yourself for the open AOTA Board of Directors position! The last two seats ran unopposed, so if you want to have a seat at the decision-making table, this is the way to do it. You have the skills to be a leader, you just have to throw your name in the ring. Nominations are due March 24th.
AOTA is also looking for an Academic Fieldwork Coordinators – Academic Leadership Council Chairperson.
If you have an opinion about the direction AOTA should take, then I encourage you to apply for a leadership position. It is great for networking and learning how the organization works, but it is also an opportunity to advocate for your perspective.
Apply and learn more at aota.org/elections
The SHARE Act
This bill is a time where I’m grateful for the people at AOTA because it is a very technical correction. This bill essentially allows the FBI and states to share with other states the fact that a background check was completed. This technical correction would allow the licensure compact to fully function.
While it has not yet been fully introduced, you can still contact your legislators and ask them to co-sponsor the legislation! Co-sponsoring essentially means that they agree to vote for the bill when it comes to floor and is a formal way of demonstrating their support.
Reps Tracey Mann (R-KS) and Joe Neguse (D-CO) will be the bipartisan co-sponsors of this bill. So if you’re in their district, make sure to say thank you!
To read the full background, head to AOTA’s Take Action Page to read about it and send your letter to your legislators!
Ask Congress to Fund the Allied Health Workforce Diversity Act
Thanks to advocacy from AOTA and people like you Congress passed the Allied Health Workforce Diversity Act that required HRSA to create a grant program for allied health programs. Now we need that program to be funded.
Sometimes things in government move frustratingly slow, but progress is still progress and we need to keep up the pressure to see this vision become a full reality!
To learn more and to contact your legislators, head to the take action page.
February 2023 OT Advocacy & Policy Updates
AOTA elections are now open through February 22nd! Make sure to use your voice and vote at www.aota.org/elections.
CMS proposes expansion of power seat elevation equipment
CMS released a proposed national coverage determination (NCD) decision that would expand Medicare coverage for power seat elevation equipment on certain power wheelchairs. If finalized, power seat elevation equipment would be covered by Medicare for Group 3 power wheelchair users. CMS is seeking comments about the benefits of this equipment from clinicians and patients, so now is the time to share your story! To learn more or submit your public comment, click here. The comment period will close March 17, 2023.
To learn more about the rule making process, check out this article on how Medicare law is made.
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January 2023 OT Advocacy & Policy Updates
Phew! The end of the year went fast. There was a bit of a hiatus with updates to this post, but good news is we have some articles to get you caught up to speed!
Public Health Emergency Update
The White House announced on January 30, 2023, the intent to end the COVID-19 Public Health Emergency on May 11, 2023. Now, technically, the PHE is slated to expire on April 11, 2023, so we will likely see a 30-day extension on that date.
Read more about how the PHE ending might impact you in this article.
October 2022 OT Advocacy & Policy Updates
Public Health Emergency Update
- The Public Health Emergency was officially renewed through January 11, 2023. This is great news for anyone using the OTA/PTA supervision waiver in private practice. This also busy practitioners more time for telehealth, OTs’ ability to complete the OASIS in all cases in home health, and other relevant waivers.
- The administration seems to be signaling that they want the PHE to end, but we shall see. HHS promised to give a 60-day notice before the end of the PHE, which will be around November 11th. So keep an eye on health news outlets that day for any announcement from HHS. If it is radio silent, chances are that we will see another 90-day renewal in January.
Time to Take Action!
There are numerous health bills in front of Congress right now. AOTA is advocating on our behalf, but they need your help! Contact your legislator today at https://aota.org/takeaction and share your story!
Current advocacy issues:
- OTA payment differential exemptions
- OTA supervision requirements in private practice
- telehealth coverage extension
- grant to improve diversity in allied health professions (which includes OT)
- reaffirming coverage of OT services for individuals with a psychiatric diagnosis
- and more!
If you don’t advocate for OT, who will?
CMS finalized Home Health Final Rule for CY 2023
CY 2023 final rule for Home Health is officially published! Home health agencies can breathe a sigh of relief as CMS did not go ahead with the proposed cuts but instead finalized a 0.7% net increase for CY 2023 instead of the originally proposed 4.2% aggregate decrease. This increase is equivalent to $125 million.
Why are there cuts in the first place? Well, when PDGM was put into place, it was done so in a budget-neutral manner. Meaning PDGM shouldn’t save or cost CMS money. The way PDGM was calculated in 2020 did result in overpayments, according to CMS, so they are now making adjustments. This cut is 7.85% but is being spread out over two years.
CMS also finalized the requirement to complete the OASIS on patients from all payers vs. only on Medicare and Medicaid patients. This requirement will be phased in during CY 2025 from January – June 30, 2025.
If you’re looking for some interesting data on therapy, check out Table B10, B3 in the final rule. CMS data shows that 30-day periods with 7 or fewer therapy visits increased between CY 2021 and CY 2020. Table B29 shows the per-visit payment amounts for LUPAs. Table B3 shows the utilization of visits per 30-day period of care by discipline between 2018 and 2021, which shows an overall decrease in service provision, especially for OT. Interesting stuff for my data nerds out there!
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Do you want to take your career to the next level, network, and gain leadership experience? Be an AOTA Volunteer!
These are the open positions:
- 2 board directors
- Development Disabilities SIS Chairperson
- Sensory Integration & Processing SIS Chairperson
- Work and Industry SIS Chairperson
- Organizational advisors
- Academic fieldwork coordinators
- Affiliated State Association Presidents (ASAP) chairperson, vice chairperson, secretary
- OTA-Academic Leadership Council Chairperson
- Representative Assembly Leadership Committee
- Representatives to the Representative Assembly (AL, AK, AZ, CA, CO, CT, DC, FL, GA, HI, ID, IL, IN, IA, KS, MD, MA, MS, MO, MT, NE, NH, NJ, NY, ND, OH, OK, OR, PA, Puero Reico, RI, TX, UT, VT, VA, WA, WV, WI
- Assembly of Student Delegates (must be a OT or OTA student)
If it is an elected position, voting will take place in February. Submit your nomination by November 18th at 11:59am EST. Check out the open positions HERE – Take a chance! You never know what will happen.
AOTA News Updates
- Nine Policies affecting OT may see end-of-year Congressional action
- GAO urgers further CMS analysis of telehealth in Medicare while MedPAC to Analyze Telehealth Reimbursement by June 2023
- Report on Bipartisan “SMART Act” will help pave the way for Congressional action
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August 2022 OT Advocacy & Policy Updates
Public Health Emergency
HHS did not issue a notice that the COVID-19 public health emergency would expire on October 14th. So, we can assume that it will be renewed for another 90 days. This is good news for all of you using CMS’s waivers for telehealth, OTA/PTA supervision, SNF 3-midnight rule, etc.
Most likely, we won’t hear from HHS again on this issue until right before or on the 14th. If you did the math, this means the next deadline would be mid-January.
- CMS is discontinuing Certificates of Medical Necessity and DME Information forms to reduce the documentation burden on clinicians and providers. CMS recognized much of this information is included in other notes so requiring these forms is duplicative in nature. Read more here
- CMS Roadmap for the end of the Public Health Emergency – Checkout this list article which provides updates on how to prepare for the end of the PHE
Physician Fee Schedule/ Outpatient/ Medicare Part B
Comments on the Proposed CY 2023 Physician Fee Schedule are due September 6th. There are a lot of changes included in this document…
- Expanded access to Accountable Care Organizations
- Updates to behavioral health services covered under Medicare
- Proposal to expand coverage of dental services for certain conditions such as organ transplant or a joint replacement
- A proposed decrease in the conversion factor to $33.08 for services paid for under the PFS (read: cut to therapy services payment and all other services under Part B) – Much of this cut can be blamed on the expiration of the temporary 3% increase allowed by Congress for CY 2022.
- Read more: https://www.cms.gov/newsroom/press-releases/cms-proposes-physician-payment-rule-expand-access-high-quality-care
- Read the proposed rule & submit a comment.
CMS: Home Health OASIS-E Virtual Workshops & Other Updates
- CMS has released new training and live webinars for the upcoming OASIS-E. The changes take effect on January 1st, and there is A LOT of change. Check out their recorded training videos first (you’ll need a few hours) and then register for the live workshops to practice coding the new OASIS.
- Tuesday, September 13 & Wednesday, September 14 from 1–5 pm ET
- Part 1: Watch training videos to learn about changes effective January 1, 2023:
- Outcome and Assessment Information Set Version E (OASIS-E)
- Standardized patient assessment data elements for consistent reporting and evaluation across post-acute care (PAC) settings
- Part 2: Register for live, virtual workshops that provide practice coding scenarios on the items covered in the training videos.
- Part 1: Watch training videos to learn about changes effective January 1, 2023:
- Tuesday, September 13 & Wednesday, September 14 from 1–5 pm ET
- New guide on using the Home Health Help Desk: https://www.cms.gov/files/document/guide-home-health-help-desksupdated-july-2022.pdf
At Amplify OT, we have a variety of resources on the OASIS listed below. If you missed the OASIS webinar it is a great resource where I walk through how to use the Guidance Mannuals to ensure you’re selecting the right score and how to look up your agency’s quality outcomes and use them to advocate for OT.
CMS released the final rule for FY 2023 and announced that CMS will now require the IRF-PAI be completed on all patients regardless of payer starting October 1, 2024. This now makes IRF more consistent with SNF where the MDS is required on all patients and this rule was also included in the proposed CY 2023 Home Health rule for the OASIS to be completed on all patients. – Read the summary here from CMS
Skilled Nursing Facility
The FY 2023 final rule is officially published for SNF, and it brings a big win for SNFs. Once again, CMS decided not to cut payment but to make an increase of 2.7% instead. The final rule also includes an update to PDPM mapping and the Quality Reporting Program – Read CMS’s summary here
CMS also has a SNF Value-Based Purchasing Program Webinar on September 28, 2022 at 2pm EST. Register here
CMS Quality Measure Training
CMS has released new quality training on eCQMs Called “Teach Me Clinical Quality Language (CQL)” – see info below from CMS
The Teach Me CQL series includes four video shorts covering several topics.
- Video #1: NormalizeInterval
- This video examines the usage of the NormalizeInterval function found in the Global Common Library used across CMS quality programs that use eCQMs.
- Video #2: Time Zone Considerations
- In this video, viewers will learn to express time zone considerations in eCQMs and be able to state the difference between the DayOf, ToDate, and precision operators.
- Video #3: Latest, LatestOf, Earliest, EarliestOf, HasStart, HasEnd
- This video explores the Global Common Library and why eCQM developers should use the Global Common Library. Viewers will also learn to define how the LatestOf and EarliestOf functions contained in the Global Common Library and additional functions called within each.
- Video #4: Coalesce
- This video delves into how to use the coalesce function in eCQM logic.
Please submit CQL-related questions to firstname.lastname@example.org. To find tools, resources, and additional CQL educational materials, visit the CQL page on the Electronic Clinical Quality Improvement (eCQI) Resource Center.
- The OT Mental Health Parity Act was introduced in the Senate by Sen. Maggie Hassan (D-NH) and Tim Scott (R-SC). This bill would expand access to OT services for mental and behavioral health disorders under Medicare and Medicaid. – Read More Here
- The House passed legislation that would expand Medicare OT telehealth waivers through 2024 regardless of when the PHE ends. Congress previously passed a 151-day extension of the waiver once the PHE ends, but this bill would buy Congress more time to find a permanent solution. However, keep in mind that the Senate would still need to pass this bill. There are other bills still being considered in Congress on telehealth. You can contact your legislators by visiting AOTA’s take action page to advocate for a permanent solution to telehealth. – Read More Here
July 2022 OT Advocacy & Policy Updates
- Skilled Nursing Facility Value-Based Purchasing (SNF VBP) – FY 2023 SNF Prospective Payment System (PPS) finalized the suppression of the use of the SNF readmission measure data for FY 2023 scoring and payment adjustments due to the ongoing COVID-19 pandemic.
- Nursing Home Care Compare: CMS updated their start rating to reflect weekend staffing rates for nurses and information on annual turnover rates among nurses and administrators. You can view this information on CMS’s Care Compare website – Medicare.gov/care-compare
CMS released their 2022-2032 framework for health equity: https://www.cms.gov/files/document/cms-framework-health-equity.pdf
June 2022 OT Advocacy & Policy Updates
SNF and IRF rules both closed for comments this month, so we can expect to see those final rules coming out in the next couple of months. The PHE is set to expire on July 15th, but we can expect to see it renewed at least until October. Keep an eye on news updates around August 15th to see if the PHE will expire officially in October or if it will continue to roll over into 2023.
OT Profession Updates/ AOTA
- AOTA By-Laws Voting Closed! After only 2% of AOTA Members participated in this election, the changes to the AOTA Bylaws were voted down.
- AOTA Released a new leadership program called Lead 360: https://www.aota.org/career/lead-360
- AOTA added to NQF Leadership Consortium – this is a huge win! Having occupational therapy represented on this important consortium is an important part of advocating for OT services and our perspective during the development of quality measures and value-based care.
- AOTA Published New Medicare Part A FAQ
- CMS Releases the OASIS-E Guidance Manual: ATTN all Home Health Practitioners! On January 1, 2023, the OASIS-E is coming your way. CMS has released the draft version of the OASIS-E early. Keep in mind that the proposed rule for HH has yet to come this year so things may still change, but CMS must not be anticipating any massive changes during this process since they have already released the manual. Check it out here
- New Home Health Proposed Rules now released: Proposals include a -4.2% parity adjustment in reimbursement, using the OASS on all home health patients, the addition of health equity sections to the OASIS, and more. Submit your comments before August 16th, 2022.
Other Health Policy News
- Promoting Health Care Quality Act of 2022: Bipartisan legislation introduced in the House to increase funding for the development of quality measures and advancing quality in health care.
- HHS is expanding Certified Community Behavioral Health Clinics (CCBHCs) funding to support the nationwide expansion of these important clinics. This expansion is good news for occupational therapy practitioners because OTPs are eligible providers in CCBHCs!
- Health insurers must post how much they pay for services starting July 1st. This is a requirement from the federal government and will allow consumers to compare how their plan compares to others.
- FDA endorsed recommendations from an advisory committee to reconfigure the COVID vaccine this fall – the CDC will determine who the target audience is for this vaccine at a later time.
- The popular app Cerebral is under fire for allegedly pressuring nurse practitioners to overprescribe antipsychotic medications to patients who may not have needed them. They are currently facing an investigation by the Department of Justice.
- CMS is proposing a new rural hospital designation to support access to care in rural communities.
- President Biden signed into law national gun reform legislation, which includes expanded background checks for individuals 18-21, incentives for “red flag laws,” and other provisions related to mental health.
Dobbs v. Jackson Women’s Health Organization Supreme Court Ruling
As occupational therapy practitioners, our lives and the lives of the clients we work with have already or will be impacted by the recent supreme court ruling. As a clinician and an individual, I support that medical decisions should be made between patient’s and their medical providers. As part of Amplify OT’s mission to support clinicians and students in advocacy, I encourage you to execute your right to petition your representatives and share your thoughts, concerns, etc.
If you’re an AOTA member, AOTA is holding two listening sessions to discuss goals and identify what type of resources would be helpful. If you’re a member, keep an eye on your emails and the AoTA website for details to register. Sessions are Wednesday, July 20th from 8-9pm est and Tuesday, August 2 from 8-9pm EST.
May 2022 OT Advocacy & Policy Updates
- AOTA INSPIRE Call for Papers: AOTA announced the call for papers for AOTA INSPIRE 2023! The deadline is June 2nd at 11:59 PST. Submitting a proposal for INSPIRE isn’t a difficult process. To make it easier, I developed a FREE course and overview on how to submit your application. Check it out here
- OT Licensure Compact Enacted in 20 states!
- CMS announced updates to Marketplace health care insurance plan requirements making OT more accessible and affordable. Read AOTA’s breakdown here
- Government Accountability Office (GAO) will study assistive tech for amputees. Thanks to advocacy from AOTA, the study will include an examination of the important role of occupational therapy. Read AOTA’s update here
- OT Student Policy Volunteer Opportunity with the Centers for Medicare & Medicaid Services: CMS is looking for OT student volunteers! The position is fully remote students will gain experience in public policy, legislation, and program development. Instructions on how to apply were posted HERE on CommunOT (must be an AOTA member to access)
Post-Acute Care (PAC) News
- CMS released the guidance manual for the OASIS-E. The OASIS-E will be implemented on January 1, 2023. Although the Guidance Manual has been released, there may still be updates as neither the proposed or final rule has been published for home health.
- CMS has also announced updates for the IRF-PAI and MDS. Many of the updates signal CMS’s commitment to improving health equity through more comprehensive data collection. The IRF-PAI 4.0 and MDS 4.0 will be implemented on October 1, 2022. These changes were originally slated for 10.1.2020 but were delayed due to the pandemic. CMS has also released a draft update for the IRF-PAI 4.1 which will be implemented on October 1st, 2023.
- The proposed rule for SNF and IRF are also currently out with the commenting period closing soon.
- CMS Fact Sheet IRF Proposed Rule: CMS has proposed using the IRF-PAI for all patients admitted to IRF similar to how the MDS is currently completed for all SNF admissions.
- IRF Proposed Rule Text – Comments due May 31st
- CMS Fact Sheet SNF Proposed Rule: Updates to rates, ICD-10 Mapping, multiple quality program updates, value-based purchasing measures, and minimum staffing requirements.
- SNF Proposed Rule Text – Comments due on June 10th
- The COVID-19 public health emergency (PHE) is currently supposed to end July 15th, 2022. However, May 16th came and went without notification from HHS meaning that they failed to give a 60-day notice for the end of the public health emergency. So, it is probably safe to assume that the PHE will be renewed until October 15th, 2022. Typically the renewal notice is published a couple of weeks before the current expiration. Although the PHE will likely renew, healthcare facilities should start preparing for the end of the PHE now.
- Kaiser Family Foundation: Nursing Facility Staff Vaccinations, Boosters, and Shortages After Vaccination Deadlines Passed
Other Healthcare News
- AOTA Volunteer positions are open, and the dates for nominations close on May 11th
- Public Health Emergency: All indicators show that the PHE will expire in July. So, practices should start preparing for any changes in practice that were instituted as part of the flexibilities allowed by the PHE. This can include telehealth, supervision requirements, and therapists initiating all home health cases. Some of these provisions expire at the end of the year the PHE expires. So, if the PHE ends in July, then the flexibilities will expire on December 31, 2022. Make sure to check the regulations for more information
- AOTA INSPIRE: AOTA’s annual conference took place in person for the first time since 2019. Check out Amplify OT’s list of Advocacy and Policy courses at INSPIRE here.
- Allied Health Workforce Diversity Bill: This legislation passed out of committee in both the House and Senate. The language of this bill is included in the Senate’s PREVENT Pandemic Act. Now we wait for a floor vote. AOTA feels hopeful that it will pass during this Congress.
- Telehealth: Congress extended the OT Telehealth waivers for 151 days beyond the expiration of the public health emergency. As stated above, is expected to expire in July. AOTA encourages you to take action and contact your legislator about the importance of passing telehealth legislation.
- Medicare Sequester: The first part of the delayed Medicare sequester started on April 1, 2022. So, you will now see a 1% reduction in all services under Medicare Part A and Part B on your reimbursement. The Medicare sequester was triggered as a budgetary gimmick last year, and Congress took action to delay the sequester. Starting July 1, 2022, the 1% will increase to a 2% across the board reduction in all Medicare spending. Click here to read our brief article about the sequester and our podcast.
You may have seen that AOTA is updating its bylaws which has caused quite a stir in the community. I have included the links to the bylaw changes below. While there are important points to be made on both sides, I encourage you to read the resources as there is a lot of misinformation about the changes floating around. There are both bylaws changes that impact the structure of the Representative Assembly and separately, there are RA proposals that change their standard operating procedure (SOP). In regards to Motion 4, you can hear the RA discuss this issue around 2hr 40 minutes and motion 5 at 3 hours 2 minutes https://www.youtube.com/watch?v=uvgOdtkGDSg.
AOTA held 3 bylaws sessions at INSPIRE and they stated they will provide more soon. Keep an eye on the linked page for updates. My browser was having difficulty loading some of the links so hopefully, it works when you access it. AOTA’s Governance Enhancement
January/February 2022 Occupational Therapy Advocacy & Policy Update
- PHE: HHS failed to provide the 60-day notice for the end of the PHE, so it will most likely be renewed for another few months in April.
- Licensure Compact Update: The OT Licensure compact has now passed in 13 states with 10 of those states have already signed it into law. This means that once the initial 10 states finalize the provisions of the compact it will become active.
- AOTA Elections close on March 9th. So, if you’re an AOTA member, make sure to vote. Your vote helps shape the future of the OT profession.
- AOTA announced a new website and membership structure. To learn more, go here
- At the end of the year, Congress passed the No Surprises Act. This is a surprise medical bill legislation that requires providers to provide good faith estimates for services for those who ask. These requirements do apply to therapy practitioners. Read AOTA’s article on the No Surprises Act
- AOTA Released their updated version of common CPT Codes used by OT Practitioners.
- Biden announced new efforts to update minimum staffing requirements for SNF, raise financial penalities for underperforming SNFs, and efforts to crack down on SNFs owned by private equities due to some staggering findings.
- “A November JAMA study cited in the fact sheet indicated the presence of private equity ownership actually led to an increase in Medicare costs despite a decline in resident care.
- A National Bureau of Economic Research working paper published in February found that over 17 years, private equity ownership increased excess resident mortality by 10% – that’s an additional 20,150 deaths associated with private equity ownership, an increase in the prescription of antipsychotic drugs by 50%, and decreased direct care staff hours by 3%.”
- NBCOT is looking for two board positions to be filled. They are a 2-year term. All applications are due by April 8th.
December 2021 Occupational Therapy Advocacy & Policy Update
It has been quite the year for healthcare policy and occupational therapy. We started the year with the vaccine and hopes for a return to normal and we are ending the year with Omicron. For those of you working in patient care, thank you. For those of you in non-clinical roles or teaching the future of the profession, thank you for supporting the profession and those who are in patient-facing roles. It takes a village and we need all hands on deck. So, cheers to a new year and new policy.
Now for the December Updates.
A sequester is an automatic reduction of federal spending. It was established in 1985 and has been used since to either encourage or discourage certain Congressional budget objectives. If the goals are not met, the sequester is triggered. In this case, the sequester impacts Medicare spending which is a federal program. Congress recently passed legislation to delay the 2% Medicare sequestration which was slated to start on January 1, 2022.
In December, Congress passed the Protecting Medicare and American Farmers from Sequester Cuts Act. This legislation impacts all Medicare Fee-For-Service (FFS) claims (Part A and Part B). The Medicare reductions will be implemented on the following schedule:
- No payment adjustment through March 31, 2022
- 1% payment adjustment April 1, 2022 – June 30, 2022
- 2% payment adjustment beginning on July 1, 2022
These cuts are in addition to any other adjustments from the Medicare Physician Fee Schedule. Keep an eye out for an article in March on this topic. In the meantime, check out this article on 2022 updates
Medicare Pay-Go: Delayed until 2023 – Originally a 4% reduction for Part A and Part B
Medicare Part B Updates
Medicare Part B Physician Fee Schedule (MPFS) Adjustment
Last year, Congress passed legislation to mitigate the MPFS conversion factor reductions by 3.75% in 2021. That temporary increase in spending was set to expire on January 1, 2022. The above legislation also included a 3% adjustment to increase spending for 2022. So, this reduces the planned 3.75% reduction to Part B reimbursement to 0.75% (3.75% – 3% = 0.75%) for the 2022 calendar year. This 0.75% reduction is in addition to the above Medicare sequester as well as the OTA/PTA payment reduction.
The KX modifier threshold for 2022 is increased to $2150 from $2100. The Medical review threshold remains the same at $3000.
Telehealth: OT and PT can continue to provide telehealth for Medicare patients through the end of the PHE. CMS did extend Category 3 telehealth codes list which includes therapy codes through December 1, 2023. However, this does not mean that therapy practitioners can bill these codes after the end of the PHE without Congress passing legislation to permanently enact this flexibility.
OTA/PTA Supervision: During the Public Health Emergency (PHE) direct supervision requirements can be met buy audio-visual communications until the end of the year in which the PHE ends. So, at this point, until December 31, 2022.
Quality Measure 154, Falls Prevention is removed from the MIPS program for 2022. Also, keep an eye out for MIPS Value Pathways (MVPs) in 2023.
Federal Legislation for 2022
Continue to keep an eye out for the following legislation in 2022. If these bills don’t pass this year, they will need to be reintroduced in 2023 as part of the new Congress.
- Allied Health Workforce Diversity Act (H.R. 3320/ S. 1679)- Expand BHWET to OTD and MSOT Programs
- Stabilizing Medicare Access to Rehabilitation and Therapy Act (SMART) (H.R. 5536) – OTA Modifier and Direct Supervision
- The Primary and Behavioral Health Care Acess Act (H.R. 3550)
- The Mental Health Professionals Workforce Shortage Loan Repayment Act (H.R. 3150/ S. 1578)
- Telehealth Extension Act (H.R. 6202)
- Telehealth Modernization Act
- Expanded Telehealth Access Act
Read more about all of the ways AOTA advocates for the occupational therapy profession in 2021 in this article. If you aren’t an AOTA member, I always encourage it because our membership supports advocacy initiatives and the longevity of our profession.
November 2021 Occupational Therapy Advocacy & Policy Update
Allied Health Workforce Diversity Act was passed out of the Energy and Commerce Committee in the House of Representatives. A big win for OT, the bill was amended to include a provision to expand the Behavioral Health Workforce Education and Training Program (BHWET) to OTD as well as MSOT programs. Read more here
- The Medicare Physician Fee Schedule was released for 2022 at the beginning of November. This PFS was much anticipated because it includes the final rule for the PTA and OTA modifier.
- CMS released their final rule for the 2022 Home Health Prospective Payment System and Value-Based Purchasing program. This rule includes a big win for OT by finalizing the rule that allows OTs to initiate and complete the comprehensive start of care for Home Health part A. AOTA’s Article. Here’s my article about the ins and outs of when OT is able to initiate the OASIS
- CMS is requiring vaccines for healthcare workers for facilities that bill Medicare and Medicaid.
“Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 6, 2021. All eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson – by January 4, 2022. The regulation also provides for exemptions based on recognized medical conditions or religious beliefs, observances, or practices. Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law.”CMS Press Release
October 2021 Occupational Therapy Advocacy & Policy Update
- AOTA introduced the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act in the House of Representatives. If passed, this legislation requires that CMS delay implementation of the OTA modifier, provides exemptions for rural and underserved areas, AND would eliminate the direct supervision requirement for OTAs under Medicare Part B. AOTA’s Article
- Allied Health Workforce Diversity Act: Now is the time to take action! Check out my article to learn about the importance of this legislation.
- The Energy and Commerce Committee in the House held a hearing on the Allied Health Workforce Diversity Act where Dr. Victoria Garcia Wilburn spoke on behalf of the bill. Watch Victoria Garcia Wilburn’s 5-minute opening statement. (You can hear some of the questioning at the 2:53:00, 3:33:45, and 3:53:46 marks)
- Pfizer vaccine approved for 5 and up
September Occupational Therapy Advocacy & Policy Update
Lots of news from AOTA this month, per usual. They have been busy at work promoting the profession of OT. If you aren’t a member, read this to see why you should be. There is obviously much news from DC regarding the debt ceiling, the infrastructure bill, etc. There are some healthcare components in the big bills on the table and once we figure out what is in the bill we will be sure to share any information that impacts OT here.
Healthcare workers approved for Pfizer booster: Read more here
AOTPAC is hosting AOTA Member ONLY events. You can view those HERE
OTA Payment Modifier Reduction
AOTA posted a really great overview article of this issue. You’ll want to read this article to learn about how to implement the OTA modifier. Per AOTA, the final Medicare Rule is expected in November! Now is the time to start preparing for the cut and consider how this will impact the flow of your clinic. As a reminder, this payment cut only impacts Medicare Part B. Humana advantage and regular plans requires use of the modifier but do not yet carry a payment reduction.
Occupational Therapy Licensure Compact
The OT compact has been signed into law in 8 states. This means we are only 2 away from the Compact becoming viable. The compact legislation requires 10 states to pass the legislation before the initial panel can be assembled. This means that for the states who pass it, the days of unnecessary paperwork and regulatory burden may soon be coming to an end. Or at least significantly lessened! As someone who just applied for a new license in a new state, the paperwork was a nightmare. Check out AOTA’s article about what states passed the compact and what states have the bill in the works! If your state is interested in sponsoring compact legislation, email Chuck Wilmarth at email@example.com. I’m also happy to talk to you about the process as I initiate and facilitate the legislative process in Missouri.
August 2021 Occupational Therapy Advocacy & Policy Update
OTA Payment Modifier Reduction
OTA Payment Modifier Reduction: Submit your comments today to stop the OTA Payment Modifier Reduction set to take effect in 2022. Read more about the OTA modifier and how to submit a comment to CMS in our latest article.
AOTA’s Annual Hill Day
AOTA’s Hill Day will be virtual this year but that doesn’t mean it will be any less effective! Hill Day is perfect for individuals of all experience levels to advocate for occupational therapy. The virtual event will take place over three days and is flexible around your work schedule. I’ll be there and I hope to see you there too! Sign up at aota.org/hillday. It’s free!
The Housing and Urban Development Department (HUD) grants are funding the Older Adult Home Modification Program (OAHMP). This program requires an OT Practitioner to supervise the home mods and address the client’s goals to promote full participation in daily activities. AOTA advocacy made this type of opportunity available to practitioners and resulted in HUD awarding 32 community-based orgs grants totaling $30 million dollars. AOTA has partnered with Rebuilding Together and they earned 4 grants from HUD. To read more about this awesome news, visit AOTA’s article.
AOTA’s Summer Series
AOTA has some great sessions available to members and non-members covering a variety of hot topics. I listed the ones below that stood out to me. If you haven’t attended an AOTA session before, I highly recommend it. I have never left feeling disappointed or uninformed.
- Private Practice Essentials for Reimbursement Webinar—Navigating Medicare for Private Practice Success. On September 14 from 2:00 pm to 3:30 pm ET
- Development and Application of the AOTA Knowledge Translation Toolkit (recorded 1.5 hrs)
- AOTA is RoOTed in Diversity: Applying a Toolkit to Address Diversity, Equity, Inclusion, and Occupational Justice – On September 16 at 2pm EST – 1.5 hrs
- Knowledge Webinar—A Call to Action: Innovation, Workforce Capacity Building, and Branding of OT– On September 23 from 10:00 am to 11:30 am ET
- Private Practice Essentials for Reimbursement Webinar—What if You Don’t Want to Deal With Insurance? Tips for Private Practitioners. – On September 28 from 2:00 pm to 3:30 pm ET
July 2021 Occupational Therapy Advocacy & Policy Update
Amplify OT Update
The Adult Rehab Guide is finally here! The Rehab Guide was created to help YOU advocate for OT and understand your role in the healthcare system. Each setting has different reimbursement and keeping it straight can be challenging. So, what are you waiting for??
The Centers for Medicare & Medicaid (CMS) published the 2022 Medicare Physician Fee Schedule (MPFS) on July 13th, 2021. The MPFS may be ringing bells since this is where CMS finalized a 9% reimbursement cut to therapy services for 2021. Congress stepped in last year to reduce the 9% reduction to approximately 3%. CMS has
OTA Modifier: The 15% payment reduction for services provided by an OTA will start on January 1, 2022, as required by the BBA of 2018. The CO modifier has been used to identify OTA services since 2020. This cut also applies to PTAs.
OT Eval Codes: AOTA advocated for a correction of CMS calculations that will result in higher reimbursement for eval codes starting in 2022.
Read AOTA’s analysis for more information on the regulatory changes and others that impact your practice.
SNF Payment Update: PDGM was implemented with the intent of being budget neutral. However, CMS found that spending increased by approximately 5% or $1.7 billion in the fiscal year 2020. As a result, CMS has adjusted reimbursement to meet the budget-neutral standard under PDPM.
OTA Confab: The OTA Confab is taking place on August 19th. The focus of this meeting is to learn how to advocate for your value as an OTA! This is a great place for OTAs and OTA students to discuss issues in the field and support each other. Free for AOTA Members and $5 for non-members Register HERE
Other Healthcare News
- Healthcare.gov Special Enrollment Period will end on August 15th. Over 2 million individuals have signed up for healthcare coverage as part of the special enrollment.
- CMS proposed an increase in the penalty for hospitals that do not publically share their price lists as required under the Hospital Price Transparency rule. A full year of noncompliance would result in between $109,500 – $2,007,500 per hospital.
- The VA will now require COVID-19 vaccinations for all patient-facing providers.
- Multiple courts have sided with hospitals that require employees to receive the COVID-19 vaccine giving other facilities the support they need to implement such policies.
June 2021 Occupational Therapy Advocacy & Policy Update
Policy/ Legislation Updates
Mental Health Professionals Workforce Shortage Loan Repayment Act (H. R. 3150/S. 1578) Is reintroduced in the 117th Congress. When this bill was originally introduced in the 115th Congress, it did not list OT practitioners as mental health providers. Thanks to AOTA’s advocacy, the bill listed OT practitioners as eligible providers when it was reintroduced. This legislation aims to set up a fund to provide loan forgiveness for mental health professionals. TAKE ACTION
CMS published the proposed rule to permanently allow OT to initiate and complete the comprehensive initial evaluation for home health. After the passage of the Medicare Home Health Flexibility Act in December or 2020, CMS finally issued the proposed rule that permanently issues OTs the ability to initiate the OASIS under Medicare Part A in therapy-only cases. This rule puts OTs on equal grounds with PT and SLP in regard to the OASIS. Of note, the current PHE allows OTs to initiate the OASIS in all cases even those including nursing. The final rule will take effect on January 1, 2022. It is expected that the PHE will be continued through the end of the year. So, we do not expect a gap between the PHE and the final rule to take effect. So, be sure to start utilizing your OTs to complete start-of-care visits!
AOTPAC is seeking Board Directors – Applications due July 28! Seeking applications for Region II, III, IV, and V. Terms are 3 years starting January 1, 2022. – Looking for slightly less commitment? Consider applying to be an AOTPAC Ambassador!
May 2021 Occupational Therapy Advocacy & Policy Update
Medicare/ Adult Rehab
Private Practice: AOTA is hosting a specialty seminar, Private Practice Essentials for Reimbursement. Sessions are live on June 15 and June 17. Topics include documentation, billing, coding, and tips for success.
OASIS Update: Check out my latest article with Karen Vance on the Medicare Home Health Flexibility Act passage. We discuss what is next for OTs and the OASIS and what steps AOTA is taking to ensure this bill is implemented. You can also read more HERE.
Health Care Reform Update – AOTA Members Only: Laura Hooper, AOTA State Affairs, breaks down the latest updates in healthcare reform in the latest OT Practice. Read all about how the American Rescue Plan Act (ARPA) expanded benefits for the ACA Marketplace and how these expansions can help occupational therapy. It’s a great summary of all that is going on in the world of health care reform. These changes impact our patients and us as individuals!
Diversity, Equity, and Inclusion
The Allied Health Workforce Diversity Act (HR 3320/ S 1679) has been reintroduced! AOTA started supporting this legislation after its first introduction in 2019. This legislation would provide funding to improve diversity in allied health professions, including occupational therapy. The legislation would also help reduce provider shortages.
AOTA DEI Toolkit: A fabulous new tool from AOTA consisting of online resources and guides for faculty, practitioners, and students. “The toolkit is intended to provide instruction and guide you through recommended action guides, exercises, and assessments. It comprises four toolsets to expand knowledge in the areas of DEI and promote further discussion. There are several suggested activities and assessments within the toolsets for additional discovery and opportunities to adapt instructional materials for scenarios.” -AOTA
Assistive Tech for Amputees: AOTA endorses the Access to Assistive Technology and Devices for Americans Study Act (Triple A Study, HR2461/ S1089). This legislation would improve funding for research regarding access to assistive tech and devices for people with limb loss and limb differences. The Government Accountability Office (GAO) would also be charged with developing a report regarding coverage of health care services for people with limb loss of limb difference, including occupational therapy.
IDEA: The American Rescue Plan (S. Con. Res. 5) includes $3 billion to fund IDEA. $2.5 billion for K-12 special ed under Part B and $450 million for early intervention covered under Part C, Part B, and Section 619.
Licenses and Continuing Education
Licensure Compact: The Licensure Compact has been passed in 4 states (Ohio, Virginia, Maryland, and Georgia), and many other states have legislation waiting for the Governor’s signature. AOTA is hopeful we will have the 10 states required to activate the Compact within the first year.
April 2021 OT Advocacy & Policy Update
Medicare Sequester: The House and Senate passed an extension of the 2% Medicare sequester moratorium through December 31, 2021. It needs to be signed by the President.
CMS Proposed Rules FY 2022: CMS released its new rules. AOTA is reviewing them now. If you have a concern, email them at firstname.lastname@example.org – keep in mind they can only respond to members due to many emails.
Post-Acute Care: In a study funded by AOTA and APTA, occupational therapy and physical therapy were found to provide significant value to patients. The study looked at 1.4 million Medicare cases across acute care. Therapy utilization correlated to improved quality of life and decreased hospital readmissions. Read more here: www.aota.org/tops. Look for an article on this from Amplify OT in the future.
Telehealth: Rep Mikie Sherrill (D-NJ) and David McKindley (R-WV) reintroduced the Expanded Telehealth Access Act (HR 2168). This bill would allow OT practitioners to provide OT services to Medicare patients after the expiration of the PHE. Use the take action page linked below to encourage your Representative to co-sponsor the legislation today!