There is a new FACT sheet on health care reform and the occupational therapy up on the AOTA Website.
Thanks to Mildred Consolo-Melchionne and Flo Hannes from SUNY Orange and Amy Solomon from Pima Medical Institute for helping to write the FACT sheet! While many of the implications for occupational therapy assistants are the same as they are for therapists the FACT sheet will be a helpful tool for our occupational therapy assistant educational programs and for use with existing staff. The FACT sheet was written with assistance from members of the Ad Hoc Committee on Health Care Reform Implementation and our great AOTA staff!
Check it out in the member area of AOTA at the following link! (Note, I updated the link which changed after the new Website was released, this link is effective 7-23, but you can find this sheet under "resources" on the Health Care Reform Implementation page under "Advocacy and Policy"
I was interested in the OTA FACT sheet and one comment in particular: "Promote the fact that OTAs are already recognized as educated, nationally credentialed, and highly skilled health care practitioners that are regulated by the state and recognized by major public and private payers as occupational therapy providers."
I am interested in other people's perspectives - but here is what I observe in NY. There are NO (as in ZERO) commercial insurance companies that I interact with that are willing to 'credential' OTAs. 'Credentialing' is the generic term used (locally) by the insurance industry to enroll a professional into 'participating provider' status in their network. Additionally, there are many Counties which previously did not allow OTAs to provide early intervention services (there are recent changes that may change some of this). Supervision of OTAs has become dramatically MORE restrictive due to recent license law changes, and Medicaid requirements for supervision of OTAs in school systems has also become dramatically MORE restrictive in recent years. I receive questions from around the State because some workers comp carriers also will not accept services provided by OTAs (generally, those can be overturned but is a common misconception, particularly downstate NY based on the geography of where I get those calls from).
Some employers (myself included) have severely restricted OTA hiring because of all the above factors. This is not a statement against OTA competency; it is simply a reaction to the regulatory environment.
In my practice, OTAs are functionally 'invisible' to the insurers because the bottom line is they want MY (as the OTR) credential on the line. They want MY NPI, MY LICENSE NUMBER, MY EARLY INTERVENTION PROVIDER STATUS, ETC.
I raise this as an issue for two reasons:
1. Is this a common or uncommon set of circumstances?
2. IF it is common, then do we need to make important resource allocation decisions about how we approach ACA issues? I would like to explain: if other professions are NOT promoting their assistant level service providers will we be diluting our own efforts to maintain equal footing? Or, if other professions are all about promoting their doctoral level and we are promoting our associates level then will we achieve the outcome that we want to achieve with the ACA?
I believe that one of the worst reasons to promote degree inflation is 'to keep up with the Jones' but there are pragmatic issues at play that we may need to consider, particularly as we are in an acute context with our lobbying, etc.
Again, I am not making statements about OTA competency or what my own particular desires and beliefs are about OTAs. I am simply making factual statements about the regulatory environment. I feel like I have been bailing water on the OTA issue in NY state for several years, and it is acutely getting worse. If there is recognition by major public and private payors - it is recognition that OTA practice has to be restricted and regulated severely - at least where I am practicing. I want our FACT sheets to acknowledge reality - because then we can all be informed and make resource allocation decisions that make sense.
If other people have very different experiences and if other states and insurance entities are welcoming OTAs it will be important to know, because if that is happening anywhere then I would like to use those models to promote OTA practice in NY State.
Christopher J. Alterio, Dr.OT, OTR
I just "found" your comment tonight and apologize for it sitting for over a month. I believe I used to get notices when there were comments waiting for "moderation" but I did not in this case and was just poking around my blog settings and saw your comment. It is late so I have not fully digested them.
I don't believe we are having any issue in Texas with OTA's being accepted by insurance as long as other requirements are met (e.g. a therapist developing the plan of care and recertifying it when necessary). I am only partly familiar with the challenges experienced in NY state and not hearing anything similar from others in other states.
I hope others can share their perspectives. Sorry again that it took so long for your comments to be posted.
I will try and read in the next day or so when I can keep both eyes open!