The Patient Protection and Affordable Care Act, often referred to simply as the ACA or Obamacare, was signed into law on March 23, 2010. The ACA is intended to expand access to health insurance coverage for millions of uninsured Americans by expanding eligibility for Medicaid and developing health insurance marketplaces where uninsured persons may be eligible for subsidies to make private health plans more affordable. While expanding access to health insurance is a big part of the ACA, there are many other purposes of the law, including provisions intended to reform the health care delivery system to produce better patient outcomes at lower cost.
AOTA was very active in the legislative process leading up to the passage and signing of the ACA, working to achieve victories such as inclusion of rehabilitation and habilitation in the essential health benefits package. AOTA has also been monitorting the regulatory process at the federal and state levels as the ACA has been implemented, and has been advocating for occupational therapy practitioners and consumers. The dynamic environment created by health care reform creates opportunities, but vigilant monitoring of implementation activities and carefully executed advocacy efforts are necessary to ensure occupational therapy is valued and protected in the future.
Please also see the Health Care Reform Implementation page on AOTA's website at: http://www.aota.org/Advocacy-Policy/Health-Care-Reform.aspx
AOTA State Affairs staff regularly partner with state occupational therapy associations to advocate for the profession. After all, the state associations are the eyes and ears to learn what's happening on the ground in real time, and they are positioned to engage in the type of local grassroots advocacy that works. AOTA can't be as effective without the assistance of the dedicated volunteer leaders and members of state associations. A recent advocacy success story in Colorado highlights the importance of these partnerships.
AOTA policy staff have been monitoring implementation of the Affordable Care Act (ACA) for years in order to identify its impact on the profession of occupational therapy, and ultimately advocate for the most favorable implementation. In doing so, AOTA has begun evaluating coverage of occupational therapy services in the plans sold on the health insurance marketplaces created by the ACA. Those plans, called qualified health plans or QHPs, are subject to the essential health benefit or EHB requirements of the ACA. The EHB requirements are great for OT practitioners and consumers, because they require coverage of habilitative services, which have often been denied by health insurance companies in the past (we've blogged about that before here, here, and here).
So what's this about an advocacy success as the result of a partnership between AOTA and the Colorado state association? Well, going back to the end of last year, AOTA staff was evaluating QHP coverage of EHBs, and discovered some problems in certain Colorado plans. Colorado has strong standards for coverage of rehabilitative and habilitative services by QHPs. The state adopted a benchmark plan to serve as the model of coverage in the state that requires 60 annual visits of OT, PT, and SLP to be covered for rehabilitative purposes. Then the state defined coverage requirements for habilitative services that require QHPs to cover them at parity and in addition to rehabilitative coverage. In other words, QHPs have to cover 60 annual therapy visits for rehab, and another 60 annual therapy visits for habilitation. The problem was that AOTA had discovered plans that weren't complying with these requirements.
After compiling the evidence, AOTA staff contacted the volunteer leaders of the Occupational Therapy Association of Colorado (OTAC) to share this information. Ongoing conversations between OTAC leaders, AOTA staff, and OTAC's lobbyists led to the drafting of a letter (download below) to the Colorado Insurance Commissioner, who is responsible for enforcement of the EHB requirements in Colorado. Unfortunately, there was no response to the letter. OTAC's leaders and their lobbyists continued to try to establish a line of communication with the Insurance Commissioner and encourage proper enforcement of the EHB requirements, but were finding it difficult to get a response. Several months after the initial letter had been sent, OTAC leaders testified at a public hearing of the Colorado Legislative Health Benefit Exchange Implementation Review Committee. That same day, an executive branch official listening to the testimony of OTAC's leaders contacted a member of the Colorado legislature with whom OTAC had communicated its concerns, to inform her that the problem had been brought to the attention of the Colorado Department of Insurance and had been resolved.
Melissa Meier Sixta, OTAC's Public Policy Chair, commented on the experience as follows. "Testifying at the public hearing was a great opportunity to speak up for our profession, educate legislators why this issue is important to the clients we serve, and impact occupational therapy on a larger spectrum. AOTA was instrumental in analyzing these health policies and guiding our state association to take action on this issue. It was critical we had our lobbyists, Kathy Oatis and Steve Balcerovich, to determine where and to whom to voice our concerns. This is just one example where public policy directly impacts practice, and it is our responsibility to make occupational therapy's voice heard."
There are many lessons learned from this experience. Success could not have been achieved without the partnership between AOTA and OTAC. As OTAC's President Audrey Aguilar said, "This was a team effort and we could not have accomplished the outcome of awareness and changes to be made in the future without the two groups working together." And perhaps more importantly, the persistence of OTAC's leaders and lobbyists, and the willingness to bring the issue up at a public hearing, is what was necessary to ensure decision makers took notice and action. Thank you to OTAC's leaders for seeing this through!
Another significant issue is that OTAC's leaders have invested in the services of a lobbying firm, which are invaluable in a situation like this. Your membership in your state association is what provides it with the resources to hire a lobbyist.
Success in Colorado may provide a guide for changes necessary in Arizona. Currently, the Medicaid coverage under the ACA lacks occupational therapy coverage for adults 22-65 in the outpatient setting, though home health care services are covered. Mary Schmitz, OT/L