Legislative Information

Added 7/10/2020 TOTA 10 Minute Legislative Update
by John Luna

News and Updates:

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), is critical to Association’s mission to advocate for the profession. AOTA wants to hear from you regarding PDGM Share your experience and read the latest survey findings on PDGM. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/PDGM-Share-Story.aspx?promo_name=Share-pymt-exp&promo_creative=Advocacy-Policy&promo_position=hero

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. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/Humana-Medicare-Implements-OTA-Modifier.aspx

Navigating 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. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/Home-Modifications-Billing-Medicare.aspx

Changes to NCCI Edits Effective January 1, 2020 In late December 2019, AOTA became aware that the Centers for Medicare & Medicaid Services (CMS) accepted two changes to the National Correct Coding Initiative (NCCI) edits effective January 1, 2020 that affect occupational therapy. Therapeutic activities (97530) and therapeutic procedures, group (97150) can no longer be billed on the same day as an occupational therapy or physical therapy evaluation. These are hard edits, and a modifier 59 will not get the services paid. https://www.aota.org/Advocacy-Policy/Federal-Reg-Affairs/News/2020/Opposing-NCCI-Edits-2020.aspx

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

State Legislative Forecast—Interstate Compact, Scope-of-Practice Challenges, and More Meghan Pudeler 11/18/2019, Meghan Pudeler is AOTA’s Manager of State Affairs State occupational therapy associations and AOTA will be busy advocating for the profession in 2020—asserting and protecting the scope of occupational therapy practice, updating state licensure laws, supporting measures to increase access to occupational therapy, and laying the groundwork to create an interstate licensure compact for the profession. http://www.aota.org/Publications-News/otp/Archive/2019/december-state-forecast

Scope-of-practice challenges Meghan Pudeler 2019  State occupational therapy associations are monitoring state legislative activity initiated by a range of health care professions seeking initial licensure or more clearly defined scopes of practice. Many of these initiatives could affect the domain of occupational therapy practice—in some cases, with an envisioned scope of practice that includes traditional areas of occupational therapy. Behavior analysts are seeking licensure legislation in multiple states, including Pennsylvania and New Jersey. Potential implications of these licensure efforts include occupational therapists who use applied behavior analysis techniques in their practice not meeting licensure requirements, and these licensure laws restricting occupational therapy practice in the future. 

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. 

Other Information: