Legislative Information

News and Updates:

No new information at this time.

PDGM Patient-Driven Payment Model (PDPM) applicable to skilled nursing facilities (SNFs), and the Patient-Driven Groupings Model (PDGM) applicable to practitioners working in home health agencies (HHAs).  In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019,  is used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.

Humana Follows Medicare Policy and Implements OTA Modifier Humana has issued a national policy change for both its Medicare Advantage and commercial plans requiring the use of the therapy assistant modifiers as directed by the Center for Medicare & Medicaid Services (CMS) final Medicare Physician Fee Schedule (MPFS) rule. Pub 100-04 Medicare Claims Processing

Home Modifications Billing for Medicare-Covered Clients Medicare-covered clients are entitled, under law, to medically necessary services. Occupational therapy practitioners do NOT have the right, under current statutes, to “opt out” of Medicare. Any occupational therapy practitioner, even those who are not Medicare providers, must directly bill Medicare for any medically necessary skilled therapy services provided to Medicare-covered clients. Whether or not to bill Medicare for home modification OT services must be based on the occupational therapy practitioner’s clinical determination of whether the services are medically necessary.  The senior list provides great resources https://www.theseniorlist.com/research/medicare-benefits-home-improvements/

Interstate Professional Licensing Compact AOTA is working on creating an interstate professional licensing compact for occupational therapy to address licensure portability. The Occupational Therapy Licensure Compact legislation must be passed into law in each state where it will apply. https://www.aota.org/Advocacy-Policy/State-Policy/Licensure/Interstate-Professional-Licensing-Compact.aspx.  

HB:1903 – The Occupational Therapy Interstate Licensure Compact – Our bill did not receive a hearing despite its support in the House, and no glaring problems in the Senate.  Texas will not have an opportunity to join the Compact again until 2023.


TOTA's annual legislative update will be held during the 2021 Conference on Friday, Nov. 5, 2021.  
The Texas Occupational Therapy Association Political Action Committee (TOTA PAC) is a state bipartisan political action committee. TOTA PAC provides financial support to candidates for state offices that support the profession of occupational therapy. 

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