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  • AOTA Federal Policy

    The ADA Education and Reform Act

    This week, the House of Representatives will act on HR 620, the ADA Education and Reform Act of 2017. HR 620 would change Title III of the Americans with Disabilities Act (ADA) by removing certain protections that allow people with disabilities to access public accommodations. Title III of the ADA currently requires equal access in all areas of public life; this includes accessibility measures in work settings, in educational settings, transportation, and public and private places open to the public. If any building lacked the proper accommodations to allow the use of that building by people with disabilities, this title provides options that would quickly address the inequality. The person with a disability is able to lodge a complaint with the Department of Justice or file a civil lawsuit, in addition to discussing the issue with the business, to remedy the situation.

    HR 620 would prevent people with disabilities from being able to enforce their rights and to press for timely removal of the barrier that impedes access. This bill would require that, in order to pursue any legal action, the person affected would first need to exhaust a lengthy process.

    First, the individual with the disability would have to provide a written notice to the business identifying the barrier to their access. Then, within 60 days, the owner would have to provide a written response outlining how they will remove the barrier. The owner would then have another 120 days to make “significant progress” on the removal. This means that up to 180 days, or up to 6 months, could pass before any legal action could occur. At this point, the business owner is only required to make significant progress in removing the barrier, not completion. This means the barrier could still exist.

    Additionally, the initial written notice must include a detailed description on how the person submitting the written notice was personally denied access. This, coupled with the time allowed to remedy any infractions, would allow businesses to wait and see if there will be a complaint instead of being proactive and ensuring access for all.  

    Occupational therapy practitioners work first hand with people with disabilities by helping them achieve independence through meaningful everyday activities. Those meaningful everyday activities often occur in a public or community settings. Those meaningful everyday activities often occur in a public or community settings. If those settings are not accessible, citizens with disabilities won’t be able to participate in important day-to-day life experiences. As this bill progresses and votes occur, it is important your Representative hear from you on how this bill would affect you, and those who rely on OT services. You can take action from our legislative action center

  • AOTA Federal Policy

    FAQ on the Medicare Therapy Cap and Repealing the Policy Once and For All

    Over the years of working on a repeal of the outpatient Medicare therapy cap I have received many questions about the therapy cap, and why its repeal was a priority for AOTA. With the passage of latest Budget bill and the permanent repeal of the cap, I wanted to provide some context for our activities and answer some of these questions.  Here are some of the most common questions and my answers.

    1.     Question: What was the therapy cap?

    Answer:  Since 1997, Medicare statute included a cap on how much outpatient therapy a Medicare beneficiary can receive each year, regardless of medical necessity. Since the policy’s enactment, Congress has kept this "hard cap" on services from taking effect, by implementing multiple, temporary moratorium and "exceptions processes”.  (An exceptions process is a process Congress puts into place to allow beneficiaries to exceed the cap). Because Congress typically acted to keep the cap from taking effect, beneficiaries were seldom denied therapy services as a result of the cap statute. Similarly, practitioners were rarely faced with telling beneficiaries they either had to pay out of pocket or forgo therapy services. 

    For 2018, the therapy cap placed a financial limit of $2,010 on occupational therapy services and a financial limit of $2,010 on physical therapy and speech-language pathology services combined. This cap went back into place on January 1, 2018 after Congress allowed the most recent exceptions process to expire.

    2.     Question: The last “exceptions process” seemed to be working, so why worry about repealing the cap?

    Answer: While past exceptions processes worked, the most recent exceptions process expired on December 31, 2017 and no longer existed as of January 1st.  Unfortunately the law of the land was a hard cap on Medicare outpatient therapy services. Until passage of this permanent repeal, we were only “renting” an exceptions process in 1-2 year chunks of time. This year, we were given the opportunity to turn the most recent exceptions process, a process that we have heard works well, into permanent policy. This meant permanently repealing the hard cap and permanently putting into place an exceptions process.

    Past exceptions processes have not always been as positive as the current one, either for beneficiaries or for providers. One past exceptions process applied an onerous manual medical review with prior authorization for services. This was both extremely burdensome for providers and caused delays in care for beneficiaries. By forever locking into place the most recent exceptions process (that did not include prior authorization), we now have a permanent policy that ensures a pathway to care for beneficiaries, and is not unduly burdensome for providers.

    3.     Question: If Congress always acted to put in an exceptions process, why didn’t AOTA spend its time and effort on other issues?

    Answer: Congress could never be relied upon to implement an exceptions process in a timely manner, and provide beneficiaries with a pathway to care. As we saw this year, Congress allowed the hard cap to be in place for almost 7 weeks.  During this time beneficiaries either had to ration care, or hit the cap.

    Without our advocacy and that of our coalition partners (which included practitioners, providers, and patient advocates) it would have been easy for Congress to focus solely on other issues for which other stakeholders were advocating. In this budget bill there were hundreds of stakeholders clamoring for their provisions. When it comes to Congress the squeaky wheel does get the oil.

    We saw the cap go into effect on January 1, 2018 after Congress failed to extend the most recent exceptions process. During the entire debate on the budget deal, we constantly heard rumors that Congress was going to extend funding for federally qualified community health centers (which we supported), but punt on Medicare policies such as the therapy cap. This would have meant a continued hard cap on therapy services. Grassroots advocacy, lobbying by AOTA and the therapy cap coalition, news stories and op-eds, and pressure by our Congressional champions helped ensure a permanent repeal of the therapy cap.

    4.     Question: Wasn’t the cap more of a problem for physical therapy (PT) and speech language pathologists (SLP) since they were combined under one cap? 

    Answer: Even though PTs and SLPs shared a cap, a report commissioned by AOTA showed that the therapy cap affected our clients more. In 2015, the last year for which there is data, 19% of Medicare beneficiaries exceeded the therapy cap for occupational therapy. This number was 16% for PT/SLP combined. Additionally, 59% of Medicare spending on outpatient occupational therapy occurred over the cap amount in 2015, as opposed to 48% of PT/SLP spending.  We believe that this is because occupational therapy practitioners tend to see more acutely or chronically ill clients, on average, than physical therapy practitioners.  While 65% of outpatient occupational therapy services were provided in skilled nursing facilities, only 27% of physical therapy services were. Of the beneficiaries who would have exceeded the cap in 2015 for occupational therapy services, 74% of them receive services in skilled nursing facilities.

    I hope this is helpful! If you have further questions, please e-mail them to FAD@AOTA.ORG

     

  • Health Care Reform

    How did 2018 ACA open enrollment numbers stack up?

    The 2018 ACA open enrollment numbers are in, and the relatively small decline in signups seems to be surprising a lot of health policy experts. The National Academy of State Health Policy (NASHP) tallied the numbers from Healthcare.gov and the state-based marketplaces and found that about 11.8 million people selected a plan, a 3.7 percent decline from last year.

    The Trump Administration cut outreach and enrollment assistance for 2018, and signups declined in states that let the federal government conduct open enrollment. States that took care of their own open enrollment saw a slight uptick overall.

    You can read the NASHP data at https://nashp.org/individual-marketplace-enrollment-remains-stable-in-the-face-of-national-uncertainty/.    

  • AOTA Federal Policy

    Congress and Repeal of the Medicare Therapy Cap

    Two weeks ago, the partial shutdown of the Federal Government was the culmination of long-standing disagreement between Congressional Democrats and Republicans about several key issues including: funding levels for defense and non-defense spending, the future of the Deferred Action for Childhood Arrivals (DACA) program, and funding for boarder security (including the boarder wall).  Other legislative issues were also caught up in this debate including the cap on Medicare outpatient services (also known as the “therapy cap”)*, the Children’s Health Insurance Program (CHIP), funding for Community Health Centers (FQHCs) to name a few.  While a long-term extension of CHIP was ultimately passed, these other issues (including the cap) still remain.

    Last October, the three Congressional committees with responsibility for Medicare and the therapy cap (two in the House and one in the Senate) drafted a bi-partisan proposal to permanently repeal the therapy cap and replace it with a review process that would ensure therapy services were medically necessary and allow beneficiaries a guaranteed pathway to care.  The proposal was the next step after year's of lobbying by stakeholders and was aided by a report commissioned by  American Occupational Therapy Association (AOTA)  that demonstrated the average cost of therapy, per Medicare beneficiary, has decreased under a similar review process (see attached, below).

    With this framework in place, AOTA, the American Physical Therapy Association (APTA), the American Speech-Language Hearing Association (ASHA), provider groups, and patient advocates were all hopeful that Congress would be able to repeal the cap once and for all by the end of 2017 (when the therapy cap was scheduled to go back into place).  However as time in 2017 was quickly running out, Congress spent the majority of time on tax reform, then passed a short-term funding for the federal government, CHIP, and FQHCs, and then went home.

    Now, in February, some Medicare beneficiaries are hitting the cap and in danger of  losing access to therapy services. Congressional champions and key staff on the relevant Committees (who are essential to passing anything in Congress) remain committed to seeing the therapy cap ended once and for all.  But the when and how this will happen remain in question.

    We have heard from the Speaker of the House, the House Majority Leader and others that the therapy cap will be addressed on February 8th as part of this next budget deal, but this result is far from certain. Everyday brings different intelligence about inclusion of a permanent repeal, and the larger forces that caused the last shut down are still in play.

     At AOTA we feel we are closer than we have ever been to a final repeal of the Medicare therapy cap. However, given the political climate, we are deeply concerned that those Medicare beneficiaries, who need therapy services now, will get caught up in the larger storm of current politics.  Congress needs to understand that they can’t forget about the therapy cap while they address other issues.  Dealing with the therapy cap must be a priority.  These beneficiaries must be a priority. Contact your Members of Congress now. Let them know they must #StoptheCap because #TherapyCantWait.

    Other Therapy Cap Resources:

    * For the past 20 years, a cap has existed on how much outpatient therapy a Medicare beneficiary can receive each year, regardless of medical necessity. Since the policy’s enactment, Congress has stopped this "hard cap" on services by implementing multiple, temporary moratorium and "exceptions processes” meaning beneficiaries have seldom been denied therapy service because of the cap.  Currently, for 2018, the therapy cap places a financial limit of $2,010 on occupational therapy services and a financial limit of $2,010 on physical therapy and speech-language pathology services combined. The therapy cap applies to all Medicare Part B providers of therapy services, except Hospital Outpatient Departments, but including Critical Access Hospitals.

  • Checking the Pulse

    Share Your #OccupationalTherapyJourney & Get Inspired By Your Colleagues

    Was there a moment in your career that defined you as a clinician? How did you get to where you are today?

    Earlier this month an OT in the U.K. shared about her reasons for becoming an occupational therapist. She asked people to use the #occupationaltherapyjourney hashtag to tell their own stories.

    Dozens of your colleagues started sharing their journeys. Some talked about how they experienced occupational therapy firsthand as a client.

    Others shared about how they were considering health care careers and were intrigued by occupational therapy.

    Several people shared how they found out about OT after a family member or loved one got occupational therapy services.

    A lot of people experienced OT during volunteer work or shadowing. They saw OT in action and wanted to be a part of it!

    You'll also find some advice when looking through the hashtag! 

    It's Your Turn!

    What are you waiting for? Go share your own journey and reasons for becoming an OT practitioner (or student!) by using the #occupationaltherapyjourney hashtag on Twitter (or Facebook or Instagram or any platform you'd like!).

    You can even leave a comment here on this post. To comment, please log in to OT Connections (it's free to join!).

  • Media Relations

    New AOTA Tip Sheet focuses on promoting the profession

    If your New Year’s resolution is to take a more active role in the future of the profession, you’re in luck. AOTA’s newest Tip Sheet is packed with tips to promote the profession of occupational therapy in the news media. (And it’s something I’ve hoped for since I started at AOTA in 2011!)

    View and download the Tip Sheet here

    Whether you like to take photos, write, or feel comfortable speaking with a reporter, this Tip Sheet offers different media activities organized by how much effort they demand. For example, submitting a photo or writing a letter to the editor of your local newspaper about occupational therapy are easier than a more involved offering yourself as an interview. Each activity features an example of an AOTA member’s work on this and includes tips to make it happen.

    And speaking of making it happen, this tip sheet was made possible by two recent graduates—Karen Stauffer and Ellery Scherrer—who made the tip sheet their capstone project.

    “We both really wanted to make a difference, and we were definitely inspired by 2017 being the 100th-year milestone for AOTA and the profession,” said Stauffer, a former journalist. “We wanted to find a way to spread the word of OT and OTs' achievements, while also being mindful of occupational therapists' very real time constraints. We hope that the tip sheet combines all those things and gives OTs a way to publicize the profession, and their own efforts, in whatever time they have available. “

    For more ideas on how to promote the profession, visit the Promote the Profession page on AOTA’s website. Additional tools for helping occupational therapy practitioners to feel confident in promoting the profession in the media (and on social media) are in the works for 2018, so stay tuned!

  • Health Care Reform

    Kentucky Approval, Letter to State Medicaid Directors Kick Off the Year in Medicaid Waivers

    Last week, for the first time, the federal government approved a state’s request to impose work requirements on Medicaid enrollees. The waiver granted to Kentucky, which will allow the state to implement a number of new conditions that apply to adults enrolled in Medicaid, is expected to be the first of several state waivers with similar provisions to be approved in 2018. Through waivers, states can pare back their Medicaid rolls without having to wait for Congress to repeal the Medicaid expansion or institute a block grant or per capita cap.   

    When states sought to change some of the terms of coverage as a condition of agreeing to the ACA’s Medicaid expansion, the Obama Administration approved things like premiums and co-pays, lockouts for nonpayment, and incentives for healthy behaviors. But it rejected work requirements, saying they did not advance Medicaid’s purpose of furnishing medical assistance to low-income Americans.

    The Trump Administration, on the other hand, is encouraging states to ask for work requirements, arguing that they are compatible with Medicaid’s goals because the long-term health of low-income people will improve as their economic standing improves through employment. Soon before announcing the approval of Kentucky’s waiver, CMS released guidance meant to help other states design their own work requirements.   

    You can read the guidance and justification for the change in policy in this letter to state Medicaid directors: https://www.medicaid.gov/federal-policy-guidance/downloads/smd18002.pdf.

    You can read Kentucky’s waiver approval letter here: https://yarmuth.house.gov/uploads/1115.pdf.

    In addition to work requirements (referred to as “community engagement requirements” because they could also be satisfied by volunteering, job skills training, or being in school), Kentucky’s plan includes:

    Monthly premiums of up to 4% of income;

    Disenrollment and lock-outs of up to six months for missing premiums, or failing to file paperwork for hours worked, changes in income or employment, or eligibility renewal on time;

    Eliminating retroactive coverage (where Medicaid can look back up to three months to pay for services provided to someone who has been found to be eligible); and

    Limits on some services, like non-emergency medical transportation (NEMT) and dental and vision care.

    Most adults on Medicaid work and most that don’t are sick or disabled, caregivers, in school, or retired, according to a Kaiser Family Foundation analysis

    Kentucky’s work requirements apply to adults between 19 and 64, with some exemptions, including exemptions for people who qualify based on SSI and people who are “medically frail” or have “an acute condition” that would keep them from complying. However, questions remain about what process the state will use to determine who is “medically frail,” and whether people with serious health conditions will lose coverage in that determination. The paperwork required to verify that you are working or exempt could also make it harder for people who are eligible to hold on to their coverage.

    To read more about the changes CMS approved for Medicaid in Kentucky, check out this issue brief from the Kaiser Family Foundation.      

  • Health Care Reform

    It's the End of the Individual Mandate

    Congress passed the tax bill this week and it awaits the president’s signature. As expected, it included a provision effectively repealing the Affordable Care Act (ACA) requirement that most individuals have health insurance or face a tax penalty by reducing the penalty to $0. While this is not ACA repeal – the law’s state marketplaces, subsidies, and pre-existing condition protections, as well as the Medicaid expansion and many other reforms are still in force – it will chip away at the Obama-era law by eroding coverage gains and increasing premiums for the people who stay covered after the penalty disappears in 2019.

    According to the Congressional Budget Office (CBO) repealing the individual mandate will lead to 4 million fewer people with health insurance in the first mandate-free year, and 13 million fewer in 10 years. It will hurt the individual market because without the mandate fewer healthy people will sign up. With fewer healthy people, the risk pool will become sicker and premiums will rise. CBO says premiums will increase about 10 percent each year over the next 10 years because of the loss of the mandate. As premiums rise, more people will forgo health insurance because it’s too expensive. And the people who stay might have fewer choices if insurance companies decide to stop selling their policies in increasingly uncertain marketplaces.

    CBO also expects that fewer people will be insured because fewer people will be enrolled in Medicaid. Some people who seek out coverage to comply with the mandate discover that they’re actually Medicaid eligible. And fewer people will take up offers of job-based coverage without a mandate pushing them to have health insurance.

    The final bill dropped a provision in the House-passed version that would have scrapped the deduction for people with high medical expenses. Instead, it temporarily makes the deduction easier to reach: people will be able to claim it after spending 7.5% of income on medical expenses, instead of 10%, in 2017 and 2018.

    On Thursday afternoon the House voted to block automatic Medicare cuts triggered by the tax bill’s deficit increase. The "pay-go" waiver was attached to legislation funding the government through January 19. Without a waiver, “pay-go” rules requiring reductions in revenue to be met with cuts in spending would require a $25 billion cut to Medicare in 2018.      

    *****

    Meanwhile, the GOP sponsors of a pair of bipartisan bills meant to reduce premiums in the individual market announced this week that Congress won’t take up their bills in 2017. They might end up attached to a large government spending bill in January.

    Alexander-Murray would fund the cost sharing reduction (CSR) payments that the president cut off in October, make it easier for states to waive some ACA requirements to experiment with new ways of managing the individual market, pay for consumer outreach and enrollment assistance, and expand the availability of low-premium catastrophic plans. Collins-Nelson would reinstate funding for reinsurance, which pays a portion of the cost of covering enrollees with expensive conditions. Senators Alexander and Collins said an independent analysis found that their bills would reduce premiums by about 20 percent for individual market enrollees who get no government subsidies.     

  • Media Relations

    'Tis the Season for Thank You's

    To say 2017 has been a big year for AOTA and the profession of occupational therapy could be the understatement of the century. Our Centennial year has been HUGE! While many in our profession are expressing their satisfaction on a job well-done, my thank you message has a slightly different angle.

    In 2017, we’ve had at least 874 positive news stories about occupational therapy. Of those, at least 432 were in news outlets that report an audience of more than 5 million. WOW. As a comparison, we counted 750 in 2016, and 799 in 2015. These numbers would not be possible without the dedicated occupational therapy practitioners who took time from their busy schedule to promote the profession. 

    So, from the bottom of my heart, thank you.

    Thank you for picking up your phone when a reporter needed a quote. Thank you for squeezing in an interview when your schedule was already booked solid. Thank you for staying on the phone with the reporter who swore they’d only take 10 minutes of your time, but really needed 30. Thank you for fact-checking. Thank you for patiently explaining the differences between PT and OT. Thank you for putting nerves aside to appear on live television. Thank you for practicing talking points. Thank you for writing that letter to the editor to correct an inaccuracy in the news. Thank you for writing a guest column in honor of OT Month or about the therapy cap. Thank you for pitching an idea to your local news. Thank you for participating in AOTA’s public awareness campaigns by hosting Backpack Safety Awareness Day or Older Driver Safety Week events that attracted media attention.

    We all have moments in our professional lives from 2017 that we will carry with us. For me, the most exciting Centennial moment was connecting with Al Roker, who was gracious enough to film a video honoring the profession that we showed at the AOTA Conference & Centennial Celebration in Philadelphia. Seeing occupational therapy practitioners who had never considered working with reporters on news stories about the profession are among others.

    What was your best OT moment from 2017?

    To see highlights of stories about occupational therapy in the news, check out AOTA’s OT in the News page, which is updated on a regular basis. To learn more about AOTA’s media efforts, visit our For the Media page. Is promoting the profession in the news one of your resolutions for 2018? Contact me at kriley@aota.org

  • AOTA Approved Provider Program

    December 2017 APP Quarterly Provider Update

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    December 2017

    New Providers

    We would like to welcome the following new providers to the Approved Provider Program:

    •AEP Connections, LLC
    •BAYADA Home Health Care
    •CEUFast, Inc.
    •CINAHL Information Systems
    •Creative Therapy Consultants
    •Johns Hopkins University School of Medicine
    •Los Angeles Unified School District Related Services
    •Performance Health Academy
    •Upstate AHEC
     

    Important Dates

    December 25–January 1, 2018:

    AOTA offices will be closed


    April 19–22, 2018:

    AOTA Annual Conference & Expo in Salt Lake City, UT

    APP Staffing Announcements

    Mike Lopatka joined us in November as the new APP Project Assistant and is doing a fantastic job. He is a graduate of the University of Iowa and has worked for a variety of nonprofit organizations and even interned with a Congressman. He has great customer service skills. Feel free to email him at app@aota.org to test them out!

    I (Karen Smith) will be retiring from AOTA on January 31, 2018, after 23 years at AOTA, 10 with the Approved Provider Program. It has been a wonderful experience serving my profession and Association as an AOTA staff member in a variety of positions including the APP Program Manager. Once my successor has been identified, that will be communicated to all of you. Thanks for your support over the years!

    Provider Spotlight

    Best Practices: Learning Outcomes

    The Employee Education System (EES) is the agency in the U.S. Department of Veterans Affairs, Veterans Health Administration that is responsible for accredited continuing education in the health professions. As such, it is also an AOTA Approved Provider of continuing education. Recently, EES was invited to share best practices related to learning outcomes that may be of interest to other AOTA Approved Providers.

    In any training prescribed as a solution to a performance or knowledge issue, it is important to fully understand what the learners are expected to know or do after the training event. Learning outcomes are the measurable results of a training activity and describe the overall goal or purpose of learner’s participation in the training event. Read more

    APP Annual Fees

    Annual fee notices (due October 1st) were emailed on August 18th to the primary contact in our database for your organization. If you have not received an invoice, please contact us immediately at app@aota.org.

    Important Login Password Changes

    As part of our ongoing efforts to provide an improved, more secure experience in the APP system, we introduced a few changes to the account management features in September.

    If you have not logged on to www.aota.org/app since September, this is how you are impacted:

    •Account passwords must now be at least 8 characters.

    o If your current password is less than 8 characters, the system will automatically ask you to change your password the first time you log in after September 13th

    •Introducing “Forgot Password” feature:

    o If you have forgotten your password, you can now reset it yourself!

    o You will need your provider ID number and your primary contact email address. Note: Please make sure your information is up to date with us. Contact us if you need assistance updating this information.

    o You will be emailed a temporary password that can be used one time. You will be immediately prompted to reset your password at that point.

    Awarding Credit

    Approved Providers award AOTA CEUs for courses that are relevant to OT. One (1) AOTA CEU = 10 contact hours of continuing education. The National Board for Certification in Occupational Therapy (NBCOT) allows .25% additional credit for courses that have an evaluation component (post-test). So a 1-hour course would be awarded 1.25 PDUs (professional development units) toward NBCOT certification renewal. This does not increase the number of AOTA CEUs. Certificates of Completion for online courses or other courses that include a post-test/evaluation component should indicate that and include the PDUs awarded, in addition to the AOTA CEUs/contact hours, so OT learners can accurately reflect this credit when submitting their certificates to NBCOT.


    Annual Conference 2018—Salt Lake City, UT

    It’s hard to beat the fantastic Conference and Exposition that we had this year in Philly at our Centennial Celebration, but Salt Lake City is shaping up to be a great one as well! Connect with occupational therapy professionals—researchers, clinicians, educators, administrators, and students as an exhibitor. Learn more about advertising, sponsorship, and exhibiting opportunities on our website.

    Quarterly Drawing

    APP learners who participate in our online program evaluation survey are eligible to win a quarterly prize of a $100 voucher for AOTA CE and products. The December 2017 winner is Laura Amundson, who participated in an visABILITIES Rehab Services, Inc, CE activity. As part of our program evaluation methods we encourage providers to email learners the survey message and link on your provider login page after CE events.


    APP Contact Information

    Karen Smith, OT/L
    APP Program Manager
    301-652-6611, ext. 2054
     

     

    Michael Lopatka
    APP Project Assistant
    301-652-6611, ext. 2834

    The next AOTA Approved Provider Program Provider Update will be emailed in March 2018. Go to www.aota.org/app and provide your provider number and password to access a variety of resources on your provider login page.

    Feel free to share the Provider Update with others in your organization.


    American Occupational Therapy Association, Inc.
    4720 Montgomery Lane Suite #200, Bethesda, MD 20814-3449