Clarice Grote, MS, OTR/L

Clarice Grote, MS, OTR/L

Will the New Congress Mean Progress for OT?

Welcome to the 117th Congress! Earlier this month, Senators and House Members were sworn in for the 117th Congress. Thus, signaling the official ushering in of Biden administration. A new Congress begins on odd years in sync with the election cycles. In the new Congress, Legislation from previous Congresses must be re-introduced to be considered.

Democrats Have The Majority in Congress

Democrats have the majority in the House and the Senate. So, we can expect to see more liberal policies than in the last 12 years. The Republicans have held the Senate since 2012 and House control has varied. However, since Democrats do not have a supermajority in the House or Senate, there must be a compromise for most legislation.

Health Care Coverage

Healthcare reform is on the table! However, it will look different from what we’ve seen for the past 12 years. Since the passage of the Affordable Care Act (ACA), there has been a strong focus on repealing it.

We can expect to see efforts for Medicare for All, lowering the eligibility age for Medicare, expanding Medicaid, and support for pre-existing conditions.

Many moderate Democrats are most interested in shoring up the ACA and reinforcing protections for pre-existing conditions. Any legislation aimed at dismantling the ACA most likely won’t be considered.

Additionally, we will most likely see increased spending on awareness campaigns and support personnel for the Marketplace. We have already seen Biden sign an executive order to start a special enrollment period for healthcare.gov. It is yet to be determined if Congress will attempt to reinstitute a tax penalty for individuals who do not have health insurance. The purpose of that change would be to counteract current court cases challenging the constitutionality of the ACA.

Congress Addresses COVID-19

Relief for the pandemic is one of the top priorities for the new Congress and the Biden Administration. Stimulus checks, hazard pay, and stimulus packages for healthcare systems are all on the table. Although it is difficult to predict what this legislation will include, we can be sure it will address vaccines, money for PPE, and financial aid for hospitals and schools.

Telehealh

We expect telehealth legislation to be a hot topic for this Congress due to the Pandemic. Under the Public Health Emergency (PHE), Medicare temporarily approved occupational therapists as telehealth providers. AOTA continues to advocate for the permanent expansion of this coverage. With the extension of the PHE, it should buy Congress some time to develop a comprehensive bill. However, as with any benefit expansion, it will most likely come with a cost associated and that number yet to be determined.

Opportunities for Occupational Therapy

Although this Pandemic has brought many challenges, it has been an excellent opportunity for OT practitioners to demonstrate our value in innovative healthcare solutions. The data collected over the PHE will provide Medicare and Congress a glimpse into how permanent solutions would impact the healthcare market.

Generally, better access to health care and health insurance is good news for occupational therapy. Medicare presently covers occupational therapy services in most situations. So, if Medicare is expanded, it could bring many Americans increased access to OT.

Special Approvals under the PHE

HHS has announced that the PHE will most likely run through the end of 2021. This means that Congress has a full year to pass legislation related to telehealth to reduce any gaps in telehealth services for Medicare beneficiaries. Additionally, OTs will be eligible to initiate and complete the comprehensive assessment for Home Health Part A through the end of the year.

This will eliminate any gap between the PHE and the implementation of the new rule to permanently allow OTs to initiate the OASIS Start of Care.

To learn more about the passage of the Medicare Home Health Flexibility Act, read our last article.

There may also be more legislation involving the therapy reimbursement cut. However, since the full 9% cut was postponed for 2 years, it will most likely be low in priority. The Omnibus Bill of 2020 reduced the 9% cut to approximately 3% in most scenarios.

How to Advocate for OT in the 117th Congress

First and foremost, you can be a member of AOTA. Membership dues support legislative action in Congress and advocacy efforts amongst government agencies. Secondly, you can subscribe to our newsletter to receive the latest information on all policy initiatives impacting OT. Remember, if you don’t advocate for OT, who will?

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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