There is information about the home health issue on the Legislative Action Center. The Legislative Action Center is used to contact your members of Congress. It is available to members and non-members. I've pasted background information and information about a bill we are lobbying for to fix the situation. I've also pasted an article about the issue from AOTA's now Chief Public Affairs Officer. The article is from 2000 but provides additional background and context. It is my understanding that the political climate for getting this bill passed is not the best. Perhaps with the November elections the environment will change. Members that drop their support for AOTA diminish the resources that we have available to impact this issue and other issues.
Gina, you state that you have dropped your AOTA membership. Without resources from you and other professionals, how are we going to convince Congress that the law needs to be changed? You mention that "my state Medicaid does not cover home health OT but does cover PT." Have you raised this issue with your state association? AOTA collaborates with state associations on issues; if your state association wants to proactively work on that issue we are willing to provide assistance but any efforts would need to be a priority for the state association first. Regarding the low vision course, I think it would be important to provide feedback to AOTA about what was missing so that we could improve the product. Chuck Willmarth Director State Affairs AOTA ***************** LEGISLATIVE ACTION CENTER http://capwiz.com/aota/issues/alert/?alertid=8747506&type=CO Representatives Robert Andrews (D-NJ) and Lincoln Diaz-Balart (R-FL) have teamed up to circulate a bi-partisan Dear Colleague Letter to all Members of the House of Representatives asking them to support and co-sponsor the Medicare Occupational Therapy Coverage Eligibility Act (H.R. 3022). The Dear Colleague Letter demonstrates the Congressmen's ongoing support of occupational therapy and will raise the profile of the legislation among House Members. Now is an important time to contact your Representative and ask that they co-sponsor H.R. 3022 which will make Medicare beneficiaries eligible for home health care coverage based on a need for occupational therapy. Use the form below to customize and send your letter to your Representative today. The more requests each Member receives will directly impact support for this legislation that is important to the integrity of the profession and the specific role of occupational therapy in the home health setting. AOTA Position: AOTA fully supports passage of H.R. 3022. Current Medicare law creates an imbalance among skilled therapy services and must be corrected. Limiting access to occupational therapy in the home health setting causes agencies to provide care according to restrictions rather than what is in the best medical interest of their patients. Placing occupational therapy on an equal footing with other qualifying services provides home health agencies and Medicare beneficiaries with a choice of the most appropriate service to meet their needs. This would improve efficiency and effectiveness of home health for Medicare beneficiaries. Background: The inequality of occupational therapy not being a qualifying service for Medicare home health benefits has been a problem for over thirty years. Occupational therapy was included in Medicare as a free standing benefit in 1987 but not eligible as a qualifying service for home health service. This problem must be addressed through legislation. Similar bills have been introduced in prior Congresses but failed to gain passage. It is essential that we raise the profile of this issue through grassroots efforts by AOTA members and direct lobbying by AOTA staff. Current law limits the appropriate use of occupation therapy in the home health setting and negatively impacts outcomes for home health care recipients by barring clinically indicated and physician authorized services. ************ http://www.aota.org/featured/area2/oldotp/link16ak.asp?PLACE=/featured/area2/oldotp/link16ak.asp ARTICLE: Advocate for OT in Home Health Christina A. Metzler The home health care qualifying service issue has been a problem of significant concern for many occupational therapy practitioners. Occupational therapy is not a qualifying service for home health care; according to law, in order to receive services under the Medicare home health care benefit, a Medicare beneficiary must be in need of nursing, physical therapy, or speech therapy, in addition to being home bound. In October 2000, a prospective payment system (PPS) is scheduled to be implemented for home health care under Medicare. That presents a new opportunity to advocate for a change in the qualifying service criteria and put occupational therapy on an equal footing with physical therapy and speech- language pathology services. AOTA will begin major lobbying and grassroots activities to promote this change. When the home health care benefit was established in the early years of Medicare, occupational therapy was not a licensed service in many jurisdictions. Occupational therapy was only paid for under Medicare in institutional settings. Even outpatient occupational therapy was not covered. Efforts since then by AOTA have resulted in a considerable expansion of occupational therapy services under Medicare. In 1986, AOTA secured Congressional approval of occupational therapy as a Part B outpatient service. This also allowed OT to be provided to skilled nursing facility patients who were no longer eligible for the Part A benefit. At the same time, OT was allowed to be provided in home health care as a continuing, stand-alone service after a qualifying visit or set of visits by nursing, physical therapy, or speech- language pathology services. Licensure is now in effect in all but two states, and a significant effort is underway to secure licensure law in California, which would provide protection for practitioners and consumers. But the continuation of unequal treatment for occupational therapy when the three rehabilitation therapies are treated equally elsewhere in Medicare law creates limits in OT home health care practice. In addition, Medicare rules are often followed by Medicaid, placing additional restrictions on the ability of consumers to access occupational therapy. Now with the new requirements in home health care to conduct the Outcome and Assessment Information Set (OASIS), the advent of an episode-based payment under PPS, and overall policy interest in increasing home health care patients' functional status, the climate is right for a push to correct this wrong. But it will require answering many questions from policymakers and even from the home health care community. It will also require aggressive advocacy by grassroots OT practitioners to create the impetus in Congress to act. The questions will include: How many additional people would qualify for home health care with OT as a qualifying service? This is a critical question because it will influence how much the change will cost. In the current environment in which home health care costs are skyrocketing and policymakers are suspicious of overutilization, we must be able to show that only a limited increase would occur. AOTA is working with the Home & Community Health Special Interest Section to find any agency or academic data to show how many people might qualify. Member help is needed. Will this put a burden on home health care agencies to increase staff? Although our ultimate goal is to increase utilization of OT, it is critical that this effort be supported by the home health care provider community. Arguments must be carefully developed, backed by data if possible, that the inclusion of OT as an initial qualifying service would provide opportunities for agencies to be more efficient in meeting beneficiaries' needs and ultimately provide the potential to save resources under the PPS. If it has been this way for more than 30 years, why change it now? AOTA will argue that it is unjust and invalid, especially under an episodic PPS, to continue this differential treatment for OT. But this argument must be backed up with data and, more importantly, the energy of the OT community advocating at the grassroots level. All members of the profession would benefit by this change, as would many Medicare beneficiaries. Please do your part. Use the home health care letter on AOTA's Web site (www.aota.org) under Government Relations to contact your senators and members of Congress. Urge your state association to send a letter endorsing the effort to your entire delegation. Work with your home health care agencies to help them understand the value of OT and this change. Use your "skills for the job of advocacy" to make this long-needed change a reality. Christina A. Metzler is the director of AOTA's Federal Affairs department. >>> [EMAIL PROTECTED] 5/11/2006 12:29 PM >>> Even though I occassionally 'bash' AOTA, I don't think that they let Medicare exclude OT from opening home health. Honestly, I don't know exactly when the exclusion took place, nor do I know any details about what AOTA did or didn't do, but I doubt that they just let Medicare dictate the rules without any input. Perhaps Chuck W. can provide us with some accurate history!!!! Ron ----- Original Message ----- From: Bill Maloney <[EMAIL PROTECTED]> Sent: Thursday, May 11, 2006 To: otlist@otnow.com <otlist@otnow.com> Subj: [OTlist] Two thoughts BM> First: BM> Gina Tate wrote: BM> 1. they dropped the ball when they let medicare exclude OT BM> (the only therapy and most functional in homes) as a qualifying BM> skilled coverage for home health BM> This has been one of the most frustrating things for me as BM> a home health OT in terms of gaining a little more professional BM> clout in a nursing and PT dominated area of practice. It has even BM> affected my ability to advance to management level with a few BM> agencies. I would have to agree with Gina wholeheartedly that our BM> national association should be in the forefront and front lines of BM> any relevant legislative issues that directly impact our practice, BM> and that with stronger lobbying efforts could advance our BM> practice! As I stated in a previous post, a major reason I BM> re-joined AOTA is so that I can complain. BM> Second: BM> Angela Jones shared a story of an OT who allegedly refused BM> to address a patient's hemiplegia. The patient was subsequently BM> "treated" by an employee of unknown credentials at the YMCA (could BM> have been a PT, or athletic trainer but doubtful at a YMCA) who BM> was willing to address the patient's concerns. Well, shame on us! BM> This is a very disturbing story on many levels. Maybe I'm old BM> school (i.e. NDT minded), but I personally can't imagine treating BM> a CVA without addressing the affected side. Since this story is BM> somewhat out of context and I certainly don't have all the facts, BM> I'll stop there. But I think a little grassroots "policing" or BM> mentoring could prevent this scenario from reproducing. BM> Sorry I've been a little dormant for a few weeks, Ron. BM> Work has been taxing and not enough time to go around. I'll try BM> to stay better connected. BM> Bill Maloney -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Help? [EMAIL PROTECTED] -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com Help? [EMAIL PROTECTED]
