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House Passes Health Reform Act
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The U.S. House of Representatives approved the Affordable Health Care for America Act November 7, by the narrowest of margins, and with only eight seconds to spare in the time allotted for voting. In session on a Saturday evening, Democrats won passage with two votes over the 218 they needed; 39 of their colleagues turned them down. All of the language AOTA has won on occupational therapy in home health remains intact.
The lone Republican who supported the legislation was Rep. Anh "Joseph" Cao (R-LA), the first Vietnamese-American elected to Congress. The other 215 Republican representatives voted in a bloc against the legislation.
Cao, who represents a district still devastated by the aftermath of Hurricane Katrina, told the press that he was keeping a campaign promise.
"I have always said that I would put aside partisan wrangling to do the business of the people," Cao said in a public statement after the vote. "My vote tonight was based on my priority of doing what is best for my constituents."
Cao defeated eight-term Democrat William Jefferson in 2008, who had been indicted on bribery charges. His district is heavily Democratic and strongly supported Barack Obama in the 2008 presidential elections.
But Senate bill watchers say the House legislation, which contains a public option for selling government-financed insurance, has no support in the Senate. Sen. Olympia Snowe (R-ME), is currently suggesting allowing a public option if within the first few years costs and premiums continue to rise and market share does not even out. Otherwise, states may be given an opt-out on publicly financed insurance.
The bill includes language that would allow home health agencies to send occupational therapists into patients' homes to do initial rehab-only Medicare evaluations when OT is included in the doctors' referral orders along with other rehab therapies.
The new language does not change Medicare's rule against covering occupational therapy-only cases. Its major effects would be to reduce the amount of time patients might have to wait for therapy and give occupational therapy much more visibility on the team.
Under Sec. 1155B of HB 3962, the Affordable Health Care for America Act, the bill clarifies Title 42 of the Code of Federal Regulations by adding these words: ".a home health agency may determine the most appropriate skilled therapist to make the initial assessment visit for an individual who is referred (and may be eligible) for home health services under Title 18 of the Social Security Act, but who does not require skilled nursing care, as long as the skilled service is included as part of the plan of care for home health services for such individual."
The American Occupational Therapy Association and hundreds of practitioners around the country have been working toward this change for the past five years. The language was included in two House bills filed in 2008 and earlier this year by Georgia Democrat John Lewis. When the health care debate began in earnest after President Obama took office, AOTA worked with congressional leaders to get the language included in a reform bill. For a full description of HB 3962, go to the AOTA Legislative Action Center Health Care Reform Hub at www.aota.org.
The bill received a major boost this week when both the American Medical Association and the AARP endorsed it because it reins in certain insurance company practices and extends coverage to millions of uninsured Americans. The bill has little GOP support, however, and the House vote, which could come Nov. 7, is expected to be close.
Meanwhile, Senate Majority Leader Harry Reid (D-NV) said recently that his chamber may not be able to pass a reform bill this year. Once one does pass, the House and Senate bills will have to be reconciled before a final product is ready for the president's signature.
EJ Brown is editor of ADVANCE.
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AOTA to Develop Electronic Doc System
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The American Occupational Therapy Association (AOTA) has announced a licensing agreement with Cedaron Medical Inc. of Davis, CA, to develop an electronic patient record and documentation system for the occupational therapy profession.
The patient record and documentation system will be based on the profession's research and literature, including the Occupational Therapy Practice Framework: Domain and Process, which presents a summary of interrelated constructs that define and guide occupational therapy practice.
The development of such a system is consistent with the profession's Centennial Vision and aligns with the movement in health care policy to improve efficiency by use of electronic health records.
Under development will be documentation templates for evaluations, assessments, interventions and outcomes specific to occupational therapy practice. "This will allow occupational therapy practitioners to meet the documentation needs established by facilities, payers, government agencies and accreditation bodies," said AOTA President Penelope Moyers Cleveland. The results will also "enable tracking of the outcomes of occupational therapy that contribute to the overall health of society."
Using Cedaron's state-of-the-art platform, occupational therapy practitioners will be able to customize the software to their individual workflow, document all components of patient care, and track outcomes. In addition, the system will allow for scheduling patients and communicating directly with billing systems without repeating any steps.
With a few keystrokes, clinical managers will be able to produce management reports on patient care operations from their offices. In addition, users participating in AOTA's national outcomes database will be able to access national and facility-based outcomes measures in OT for benchmarking patient progress.
The system will be specifically designed to capture outcomes data using the Boston University Activity Measure for Post Acute Care (AM-PAC™). The AM-PAC, an outcomes instrument provided by CREcare, LLC, assesses a client's functional status across basic mobility, daily activities and applied cognition.
The AOTA documentation system will be compatible with ASHT Connect, SLP Connect by ASHA and APTA Connect, which will allow for a common electronic platform across the occupational therapy, physical therapy and speech language pathology professions.
Cedaron Medical Inc., founded in 1990, currently dominates the health care "outcomes" market, with specifically designed software for many medical specialties. To date, the company has served more than 800 facilities in 15 countries and owns five related patents.
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TOTA Puts CE into Webinar Format
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Despite the fact that its high quality continuing education is consistently identified in member surveys as being an integral benefit of belonging to the Texas Occupational Therapy Association (TOTA), many OTs and OTAs are unable to take advantage of the opportunities due to the great distances that they need to travel to a host facility.
After working with several companies, the Texas Occupational Therapy Association has begun a relationship with MegaMeeting, a service that provides for the sharing of the speakers and presentations through a Web site host using a webcam and voiceover Internet protocol (VOIP) to allow high-quality professional development offerings to be viewed in real time and interactively to geographically diverse groups,
The Gulf Coast East District, located in the southeast area of Texas, has begun hosting its monthly professional development meeting using the MegaMeeting service. A session will be offered at the 2009 Mountain Central Conference in San Antonio Nov. 13-15, 2009 (see print ADVANCE for Occupational Therapy Practitioners, Oct. 26) during which potential site hosts will be trained in the guidelines for use of the site so that even more members can take advantage of the service.
Led by former TOTA President Mack Ivy and current President Lynda Jennings, TOTA's district chairs explored various webinar formats, gathering information on the features of the services available, quality of technical support, the costs of running such a program including hardware and monthly fees and what would be involved in setting up guidelines for use before selecting MegaMeeting.
The association hopes the new technology will allow it to be even more responsive to the professional development, information needs and educational requirements of its members, and to advance and improve the practice of occupational therapy for the benefit of the consumers.
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Hard-Won Victories for OTs
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When the Senate Finance Committee voted Oct. 13 to approve America's Healthy Future Act, the final draft of the bill included some hard-won victories for occupational therapists:
? PTs will not get sole possession of direct access to clients (being allowed to treat without a doctor's orders). Instead of passing an amendment that would have allowed that, to the specific exclusion of occupational therapists, the committee opted to suggest that the Centers for Medicare and Medicaid Services (CES) study the impact of direct access for all rehabilitation professions to determine what its effect would be. The study is not mandated.
? Proposed changes in Medicare's payment structure to providers of orthotics and prosthetics would have stopped certain OTs from practicing in that field after 2013 and severely restricted reimbursement of OTs doing orthotics. AOTA's hard lobbying against the measure helped stop it from going through.
? A two-year extension to the Medicare therapy cap exceptions process is included in the bill and in all other health reform bills as they now stand.
Issues that still need some work include getting the Senate to include habilitation and rehabilitation as covered services in any new insurance products that health care reform produces. Though rehab is covered under outpatient services, it is not yet specified as a mandate in insurance contracts. According to AOTA reports, it is expected to be added before the bill goes to the Senate floor.
The language of a bill that would have allowed occupational therapists to open Part A home care cases when OT was a covered service is not in the act at this point, but the national association is still lobbying to get it into the final legislation.
There now exist two Senate bills and three House bills that each chamber must combine into the one upon which it will vote. That work is expected to go on for six to eight more weeks. For more detailed information on this update, go to www.aota.org.
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Does the EEOC Prohibit PTs, OTs from Administering FCEs?
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Doing functional capacity evaluations has long been a specialty of physical and occupational therapists who are trained in evaluating an individual's capacity to fulfill his or her job responsibilities after healing from an injury or illness.
But precisely because they are licensed health care professionals, PTs and OTs may be caught in a legal bind over their right to do such exams.
Therapists themselves don't think of FCEs as medical tests, but last month a federal appeals court in Oregon ruled that any tests administered by "health care professionals" are "medical" tests. Such examinations are prohibited under the Americans with Disabilities Act (ADA) unless they can show the exam is "job-related and consistent with business necessity."
In this particular case, the court said that the plaintiff, an injured mill worker, may sue Georgia-Pacific Corp. over her FCE, which was conducted by a licensed occupational therapist and included general physical evaluations that indicated not only her functional ability to do specific job skills, but her response to the stressors of doing the tasks.
The OT recommended keeping Kris Indergard off the job. Under its current policy, Georgia-Pacific fired the woman because she had been out of work longer than two years.
Indergard sued.
She had taken a medical leave from her job in 2003 to under go knee surgery for both work-related and non-work-related injuries.
An earlier district court decision had held for the company. But the federal court added another standard: the EEOC's Enforcement Guidance on Disability-Related Inquiries and Medical Examinations (available at http://www.eeoc.gov/policy/docs/guidance-inquiries.html), to determine the legality of testing. Those guidelines identify seven factors that weigh against the legality of an FCE:
1. whether the test is administered by a health care professional;
2. whether the test is interpreted by a health care professional;
3. whether the test is designed to reveal an impairment of physical or mental health;
4. whether the test is invasive;
5. whether the test measures an employee's performance of a task or measures his/her physiological responses to performing the task;
6. whether the test normally is given in a medical setting; [and]
7. whether medical equipment is used.
The circuit court identified four violations of these particular standards that held in the plaintiff's favor (1, 2, 3, and 5).
In the 2-1 decision, the majority said that the occupational therapist was, indeed, a medical professional, who should have been neither giving nor interpreting the test. Also, "the broad reach of the test was capable of revealing impairments of her physical and mental health, particularly in light of . recording Indergard's subjective reports of her current pain level, use of medication and assistive devices, and communication, cognitive ability, attitude, and behavior," the justices explained.
[The OT] recorded [Indergard's] heart rate and breathing pattern after the treadmill test, and [her] muscle pain and stiffness after the first day of testing. These are measurements of Indergard's physiological response to her performance of a task and, as discussed above, go beyond collecting information necessary to determine whether Indergard was physically capable of performing the task."
This is the first time a federal appeals court has weighed EEOC standards to decide what is and is not a medical exam.
The one dissenting judge rejected the EEOC's Enforcement Guidance as "subvert[ing] the plain text of the statute." [The PCE did not cause the employee to lose her job (i.e., she would have failed the lifting requirements to return to work), she would have no claim anyway.]
The majority interpretation "would have to allow injured workers to return to the job without being able to verify their fitness for duty, creating the potential for re-injury," he told the online magazine Business Insurance.
In an article in its Oct. 5 edition, Clay Creps, chair of the employment law practice group at Bullivant Houser Bailey P.C. in Portland, OR, advised employers to have "a written protocol for return-to-work exams that states the only thing that exam is to explore is whether the injury or illness that caused the person to be out of work has healed to the point that they are now capable of performing the function."
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Disabled Students Are Spanked More
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According to the New York Times, more than 200,000 schoolchildren are paddled, spanked or subjected to other physical punishment each year, and disabled students get a disproportionate share of the treatment, a new study says.
Sam Dillon reported on Aug. 10 that "most states prohibit corporal punishment in public schools, but 20 do not. The two watchdog groups that collaborated on the report, Impairing Education, Human Rights Watch (www.hrw.org) and the American Civil Liberties Union (www.aclu.org) are urging federal and state lawmakers to extend the ban nationwide and enact an immediate moratorium on physical punishment of students with disabilities."
Meanwhile, "Corporal punishment is just not an effective method of punishment, especially for disabled children, who may not even understand why they're being hit," Alice Farmer, who wrote the report, told Dillon.
U.S. Department of Education data says about 19 percent of almost 224,000 public school students who were paddled during the 2006-7 school year were students with disabilities, who make up 14 percent of all students, said the Times.
"Corporal punishment is still permitted in some form in Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Wyoming.
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Get Set for Capitol Hill Day 2009
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Last year more than 200 OTs, OTAs and students gathered at the U.S. Capitol to advocate for their patients and their profession. According to AOTA's Web site, "feedback was overwhelmingly positive from attendees and policy makers alike."
The 2009 Capitol Hill Day is set for Oct.5, 2009, and your attendance is even more critical this year to assure improved access to OT as the health care reform process continues, no matter what form it finally takes.
Besides the main Hill Day, AOTA has scheduled additional Hill days for some specific groups:
- Program directors, Thursday, Oct. 8
- AOTA Board of Directors, Thursday, Oct. 29
- Student conclave attendees: Friday, Nov. 20
You don't even have to do this by yourself. You can bring a friend, a colleague or your family.
This year discussion will be on the following OT-specific issues in the context of Health Care Reform:
- OT in Home Health
- Medicare Therapy Caps
- OT's Role in Prevention, Wellness and Care Management
- OT's Role in Treating Autism Spectrum Disorders in Children, Adolescents and Adults
- Workforce Issues in Healthcare and Education
To register for AOTA's Capitol Hill Day, go to www.aota.org, "where you will find the registration form, frequently-asked questions about the event, and pointers on how to set up a successful congressional meeting with your senators and representative."
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Many States Not Meeting IDEA Mandates
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More than half the states in the United States are likely not meeting the requirements of the Individuals with Disabilities Education Act (IDEA), and 10 of them may stand in danger of losing federal funding for the program.
The information surfaced when the U.S. Department of Education's Office of Special Education and Rehabilitative Services released information in June on how well the states were implementing the civil rights law as of 2007.
The 2004 amendments to IDEA require each state to develop a state performance plan (SPP) that "evaluates the state's efforts to implement the requirements and purposes of IDEA, and describes how the state will improve its implementation." Although regulations to cover the reauthorization have not yet been approved, OSER is collecting information required in the law. According to their own determinations, 24 states were not meeting the requirements of IDEA in U.S. schools, and 26 states were falling behind in Part C, early, family-based intervention for children birth to 3 years old.
The SPP includes "baseline data, measurable and rigorous targets, and improvement activities for 20 indicators such as graduation rate, dropout rate, participation and performance on assessments, meeting evaluation timelines, and ensuring that complaints and hearings are resolved within required timelines," DOE's Web site states.
DOE is required to issue annual determination letters to each state on its progress in meeting the requirements of the statute in four specific categories:
? Meets the requirements and purposes of IDEA,
? Needs assistance in implementing the requirements of IDEA,
? Needs intervention in implementing the requirements of IDEA, or
? Needs substantial intervention in implementing the requirements of IDEA.
According to DOE's Web site, "If a state 'needs assistance' for two consecutive years, the department must take one or more enforcement actions, including among others, requiring the state to receive technical assistance, designating the state as a high-risk grantee, or directing the use of state set-aside funds to the area(s) where the state needs assistance.
"If a state 'needs intervention' for three consecutive years, the department must require a corrective action plan or compliance agreement, or withhold further payments to the state. Any time a state "needs substantial intervention" the department must take immediate enforcement action, such as withholding funds or referring the matter to the department's inspector general or to the U.S. Department of Justice."
Following is each state's performance in meeting the requirements of IDEA Part B, which serves students with disabilities, ages 3 through 21:
Part B
Meets Requirements
Alabama, Alaska, Arkansas, Arizona, California, Commonwealth of the Northern Mariana Islands, Connecticut, , Hawaii, Idaho, Iowa, Kansas, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, North Carolina, North Dakota, New Jersey, Ohio, Oklahoma, Oregon, Republic of Marshall Islands, South Dakota, Utah, Virginia, Washington, Wisconsin and Wyoming
Needs Assistance
Delaware, Guam, Pennsylvania, Puerto Rico, Texas, Virgin Islands and Vermont
Needs Assistance 2 consecutive years
American Samoa, Federated States of Micronesia , Florida, Georgia, Illinois, Kentucky, Massachusetts, Maine, Nebraska, New Hampshire, Nevada, New Mexico, New York, Palau, South Carolina, Tennessee and West Virginia
Needs Intervention
Bureau of Indian Education, Louisiana and Rhode Island
Needs Intervention 3 consecutive years
Colorado, District of Columbia and Indiana
Following is a list of each state's performance under IDEA Part C, which serves infants and toddlers birth to age 3:
Part C
Meets Requirements
Alabama, Arkansas, Commonwealth of the Northern Mariana Islands, Connecticut, Delaware, Iowa, Idaho, Illinois, Indiana, Kansas, Maryland, Massachusetts, Minnesota, Missouri, Montana, North Carolina, Nebraska, New Hampshire, New Jersey, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, West Virginia and Wisconsin
Needs Assistance
Alaska, Maine, South Carolina, Tennessee, Texas and Wyoming
Needs Assistance 2 consecutive years
American Samoa, Arizona, California, Colorado, Florida, Guam, Hawaii, Louisiana, Michigan, Mississippi, New York, North Dakota, Ohio, Puerto Rico, Utah, Virginia, Virgin Islands, Vermont and Washington
Needs Intervention
Georgia, Kentucky, New Mexico and Nevada
Needs Intervention 3 Consecutive Years
District of Columbia
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AOTA Legislative Alert: Home Care
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The continuing health care reform debate on Capitol Hill is giving occupational therapy a new opportunity.
Last February Rep. John Lewis of Georgia (D-5) sponsored a bill that would allow home health agencies to use occupational therapists to assess a patient's eligibility for the Medicare Part A home-health benefit in a rehab-only referral, as long as OT is one of the services requested on the doctor's plan of care. It would give home health agencies more people to juggle for collecting the initial OASIS data on the case, which is very performance-oriented. The change would not make OT eligible to treat without other qualifying services preceding it.
HR1094, the Home Health Flexibility Act, has seen no action to date. Now, AOTA staff sitting in on committee hearings on health care reform legislation hope to get lawmakers' attention and have HR1094's provisions included in a reform bill.
To contact your lawmakers through AOTA's Legislative Action Center, go to http://www.aota.org/News/AOTANews/Health-Reform-Update.aspx
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Feds Tap 145 for Medicare Fraud in 4 States
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Federal agents moved in to arrest 32 people, including doctors and medical equipment shop owners and employees in Texas July 29 for Medicare fraud that amounted to $16 million. Meanwhile, individual arrests were also made in Louisiana, Massachusetts and New York. The raids brought the total of false claims uncovered since May to $371 million. Suspects in the latest raid included people involved in a scam to provide "arthritis kits" that contained braces that many patients told investigating agents they didn't need and never used.
According to major news sources, including the Associated Press, clinic owners allegedly charged Medicare between $3,000 and $4,000 for each kit. It is not clear where the kits came from.
Other charges were for billing Medicare for wheelchairs that were not delivered to patients, were duplicate claims, or were allegedly medically unnecessary. Some businesses and personnel were allegedly getting kickbacks from the orders.
Indictments have been handed down by a Houston grand jury against seven specific Texas companies and specific employees listed on the Centers for Medicare and Medicaid Services Stop Medicare Fraud Web site.
The fraud has been spreading out from Miami in the past two years to other cities and new practice arenas such as "home care, physical therapy and infusion drugs," New Orleans Metro Real-Time News reported last Thursday, and criminals "have started tapping into Medicaid Advantage, which allows the elderly and disabled to get benefits through private health insurers" through a government subsidy.
And it's not just health care personnel who are benefitting from fraud. The News reported that Kirk Ogrosky, deputy chief of the U.S. Justice Department's criminal fraud section, confirmed that some patients in Miami were raking in more than $1,000 a month by scamming the federal government. He indicated that in some Miami neighborhoods it had become a cultural norm.
Medicare fraud strike forces were created in 2007 as part of CMS's Health Care Fraud Prevention and Enforcement Action Team (HEAT) to investigate rampant fraud in Miami that authorities estimated to be $3 billion a year, much of it in claims for wheelchairs that were never delivered to patients, the News reported. Within the past year, teams of agents, each headed by a federal prosecutor, moved into Los Angeles, Detroit and Houston, where the latest bust was made. There, besides the "arthritis kit" scam, practices were allegedly billing Medicare for "thousands of dollars worth" of cans of dietary supplements that never got distributed to patients.
The fast-moving arrests are due in part to millions of dollars that have been added to the till for insurance fraud investigation. With that money, Atty. General Eric Holder and HHS Sec. Kathleen Sebelius poured dozens more agents into the strike forces.
According to the Metro News, federal authorities have not only issued indictments but frozen bank rank accounts and seized expensive cars and homes allegedly purchased with stolen Medicare funds.
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AOTA Projects Net Increase for FY '10
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The AOTA Board of Directors adopted its FY 2010 budget last month, with the expectation of ending the fiscal year with a net increase of just over $203,000 despite the floundering economy.
The new budget includes revenues of $15,449,819 and expenses of $15,246,729. Centennial Vision initiatives, including those to increase the influence and awareness of the profession and make it more evidence-based, are prioritized, according to a report on the AOTA Web site. The priorities are:
- engaging in broad-based advocacy to ensure funding for occupational therapy in traditional and emerging areas,
- creating a national outcomes database,
- continuing to develop the branding/image-building campaign,
- promoting dissemination of evidence-based knowledge,
- monitoring research developments and creating an ongoing database of research initiatives within the profession,
- completing a revised research agenda for the profession, and
- implementing the next phase of leadership development efforts.
"Outside economic factors that have negatively impacted Association revenues, such as print advertising, building rental income, and investment income, were all evaluated closely to assure that the budget was built using attainable but conservative revenue projections," the report said.
AOTA President Penelope Moyers Cleveland noted, "The steps taken this past winter to re-align AOTA operations have positioned us well to focus on our future. We will actively monitor our financial position throughout the new fiscal year and make adjustments when needed to ensure the goals of the Association are met."
The budget covers AOTA's fiscal year which begins July 1, 2009. To read the full report, go to www.aota.org
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Army to Do 'Largest Ever' Suicide Study
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Last year, the rate of suicides in Army combat personnel age 44 and under exceeded, for the first time, the suicide rate of young men in the general population. Now, four of the nation's leading universities will carry out the largest study of suicide and mental health among military personnel ever undertaken.
According to Newswise, "The announcement came last week from the National Institute of Mental Health (NIMH), which signed a memorandum of agreement with the Army in October 2008 authorizing the. investigation. Study investigators aim to move quickly to identify risk and protective factors for suicide among soldiers and provide a science base for effective and practical interventions to reduce suicide rates and address associated mental health problems."
Suicide is, in fact, the fourth leading cause of death among 25- to 44-year-olds in the United States. "Historically, the suicide rate has been lower in the military than among civilians," the Newswise report said. But, "in 2008, that pattern was reversed, with the suicide rate in the Army exceeding the age-adjusted rate in the civilian population (20.2 out of 100,000 vs. 19.2)."
While the stresses of the current wars, including long and repeated deployments and post-traumatic stress, are important potential contributors for research to address.the study will examine a wide range of factors related to and independent of military service, including unit cohesion, exposure to combat-related trauma, personal and economic stresses, family history, childhood adversity and abuse, and overall mental health," Newswise said.
The four schools undertaking the coordinated study include Columbia University, New York; Uniformed Services of the University of the Health Sciences, Bethesda, MD, the University of Michigan at Ann Arbor and Harvard Medical School, Cambridge, MA.
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Hormonal Connection to Lung Cancer?
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The New York Times reports that "women who have both ovaries removed along with the uterus in order to prevent ovarian cancer may increase the risk of lung cancer."
University of Montreal scientists discovered "that women whose menopause had been induced medically" were 1.92 times more likely to develop lung cancer than "women who had experienced natural menopause."
The study was published online in May in The International Journal of Cancer.
What's the connection? Scientists aren't sure, but it may be due to plummeting hormone levels after the ovaries are suddenly no longer there.
A similar finding recently came out of the ongoing Nurses' Health Study. It was published in the Journal Obstetrics and Gynecology in May, which reported that "women who had had hysterectomies but kept their ovaries lived longer than women who had had the procedure but whose ovaries were removed.
"While those who had their ovaries removed were less likely to develop breast cancer and virtually eliminated their risk of ovarian cancer, they were more prone to heart disease and were at greater risk for other kinds of cancer, including a doubling of the risk for lung cancer among those women who never used hormone therapy," the Times reported.
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Arkansas Adding New OTA Program
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East Arkansas Community College, Forrest City, AR, has announced plans to add an occupational therapy assistant program. The program will operate under the community college's allied health sciences department and anticipates admitting its first class in the fall semester of 2010, pending approval of the Arkansas Department of Higher Education Coordinating Board and receipt of developing program status by the Accreditation Council for Occupational Therapy Education (ACOTE).
Funding for the program has come from a U.S. Department of Labor grant to raise the skill level of the workforce to transform the economy of the Arkansas Delta, according to a press release. The new OTA program will become the state's third, the others operating in Little Rock and El Dorado.
"Students interested in applying to the OTA program need to be aware that there are required prerequisite courses that must be completed prior to application," said Janie Bailey, department chair of allied health sciences. "The fall semester is a great time to get started in moving toward the process and to make contact with the department to investigate the program and to speak with an advisor."
According to the press release, there are a number of scholarships available for EACC students enrolled in allied health programs. For more information, contact the EACC Allied Health Science Department at 870-633-4480, ext. 270.
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FL Contractor Restores Code
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First Coast Service Options Inc., which serves Florida, Puerto Rico and the U.S. Virgin Islands as a Medicare administrative contractor, will return to covering OT assessments for assistive technology under CPT Code 97755, after AOTA charged the contractor with non-compliance with national Medicare policy.
In a local policy decision, First Coast had eliminated CPT Code 97755 from its list of therapy service codes. The move prevented occupational therapists from assessing people with serious disabilities for devices that could help them stay functional.
In a July 16 request for reconsideration, AOTA told the contractor that it may be "contrary to Medicare national policy for First Coast to arbitrarily eliminate a Medicare-covered service. This action goes way beyond an interpretation of what a service entails." Code 97755 has been a covered Medicare service since 2004.
AOTA's reconsideration request argued that CPT code 97755 is an "essential code for those beneficiaries with severe conditions, such as spinal cord injuries, that require a sophisticated assessment of available technology, the patient's abilities, and his/her environment in order to assure the best "fit" for optimal functioning."
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White House Predicts Continued Job Growth in Health Care
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The White House Council of Economic Advisors recently released a report stating "health care is forecasted to remain a large source of job growth in the labor market" through 2016. Preparing the Workers of Today for the Jobs of Tomorrow describes employers' continuing need for employees who can "think critically and solve problems" and have a "post-secondary education."
According to an AOTA release, the council indicates in the report that growth in health care occupations does not take into account comprehensive health care reform. "Health care reform is expected to slow the growth rate of health spending as efficiency is improved; however, even with a slower growth rate of spending, the expected expansion of health coverage could lead to increased demand for workers.to cover the newly insured population," the group stated.
The report specifically mentions non-physician clinicians, which would include occupational therapy.
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Advocates 'Light the Night' For Disparities Reform
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Hundreds of health care workers, doctors, nurses and other frontline caregivers joined activists, organizers, health care equality advocates and other Americans in Washington, DC, Wednesday night June 24 to demand that Congressional reform efforts address systemic inequality in the American health care system.
They gathered at Freedom Square, two blocks from the White House at Pennsylvania Avenue and 14th Street from 7 to 9 p.m., to hear speeches by reform-minded members of Congress and others interested in increasing access to community-based health care.
"The consequences of more delay are grave," Congresswoman Lucille Roybal-Allard (CA-34) chair of the Congressional Hispanic Caucus Health Task Force, told the group. "Injustice in the health care system is literally killing communities, and the time for action is now. to achieve a nation free of health disparities, with quality health outcomes for all, regardless of ethnic, racial or cultural background."
The event was hosted by the Health Care Equality Project, a broad-based coalition of organizations and individuals who represent providers and consumers across the nation. Advocates sent a loud and clear message to Congress last Wednesday with thousands of calls and hand-written notes to the effect that a just reform package must pass this year, and it will have to make concrete investments in eliminating life-threatening disparities.
Event-goers participated in a moving "speak-out," where they verbally shared their personal difficulties overcoming obstacles in an unequal system. Participants across the country also shared individual experiences and stories on thousands of postcards to be hand-delivered to members of Congress by the Healthcare Equality Project. Additionally, they were given the number1-800-577-1635 to distribute in their communities that will connect callers to their members of Congress so that they can personally deliver an equality message and a call for change.
The evening culminated with a candlelight vigil to "light the night" in remembrance of those who have suffered or died due to disparities in the system.
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A case that directly involves occupational therapy under the Individuals with Disabilities Education Act (IDEA) may go before the U.S. Supreme Court next winter if the court chooses to hear it. The outcome could affect the way all related services are delivered in the schools.
In Jacob Winkelman et al. vs. the Parma (Ohio) City School District, a child with autism is asking the high court to overturn a 6thCircuit Court of Appeals ruling that would allow courts to make decisions about the need for related public school services based on things other that what is written in a child's Individualized Education Program (IEP).
Jacob Winkelman was 6 years old in the spring of 2003 when he was set to begin his kindergarten year in the Parma City School District in Parma, Ohio. Jacob had already been receiving therapy at his pre-school, and in preparation for the 2003-2004 school year, the school district had conducted an evaluation of Jacob's needs. According to a statement of relevant facts in the case, in May 2003, based on that evaluation, his OT recommended that therapy be continued because the boy was progressing well with it where he was. The school agreed and signed a team summary and interpretation-of-evaluation document to that effect for continued OT through the summer.
The following month, however, the district presented the family with an IEP the parents hadn't agreed upon; it required Jacob to be re-evaluated for continuing OT services by Sept. 30 in order to receive them in elementary school. The IEP also did not guarantee him other related services that his parents felt had been agreed upon. Jacob's parents took him out of the public schools and enrolled him in a private school. When an administrative hearing officer ruled against their complaint, they filed a lawsuit in federal court.
The school district won its case in three appellate courts by bringing in information supporting its ability to provide such services even if they weren't on the IEP. But in three other appeals, circuit courts ruled against the district, saying that the IEP is the only document of record in such cases.
At issue in this debate, says Attorney Prashant Khetan of Troutman Sanders LLP in Washington, DC, is holding school officials to the bar in obeying the law. His law firm is filing friend-of-the-court briefs on behalf of Jacob Winkelman's request to have the Supreme Court hear the case.
"The 6thCircuit has given the schools the ability to not put any related services into an IEP," he told ADVANCE. "They will be able to say at any time, 'well, we intend to put it in at some point,' and [if the case goes to court] you end up with a 'he said-she said' situation."
Seven organizations, including AOTA, have filed amici briefs in the case.
Whether the high court will hear the case is still at issue. The Supreme Court must sort through some 5,000 pleas from petitioners who seek to have their cases heard each year. Four of the seven justices must agree that a case should be heard in order to place in on the docket.
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A 23-month-old child in Texas has died as a result of the swine flu on Wednesday. The toddler is the first fatality from the condition reported outside Mexico.
Richard Besser, MD, acting director of the CDC, confirmed the fatality and stated he didn't believe "this indicates any change in the strain of the flu."
"Even though we've been expecting this, it is very, very sad," Besser added. "As a pediatrician and a parent, my heart goes out to the family."
"I expect we'll see more cases," Besser said. "And as we do, we'll learn more about this, and if there needs to be more stringent or less stringent recommendations, we'll be making those."
Confirmed Cases
The number of confirmed U.S. cases of swine influenza A (H1N1) virus - swine flu - climbed to 64 early on April 29. The cases are still only in the five states where they previously were reported.
That brings the total confirmed cases to 45 in New York City, 10 in California, six in Texas, two in Kansas and one in Ohio. State health officials in California have confirmed three other cases, and Indiana authorities have confirmed one.
This increase is not surprising. Over the past several days, CDC officials have stated they expected to see an increase in both confirmed cases and severity of illness.
The swine flu virus can be transmitted between humans. It is not clear yet how easily it is transmitted, nor how it is transmitted. It is very likely transmitted by sneezing and coughing, and by skin-to-skin contact with an infected person.
Hospitals Taking Action
Hospitals across the country are preparing.
"Even if we got nothing more than a few more sporadic cases, it's been a great exercise for our whole hospital staff," Thomas Tallman, DO, FACEP, assistant director for Cleveland Clinic Event Medicine in Ohio, and medical director for Disaster Preparedness of the Emergency Services Institute, told Newsweek. "If this illness goes further in America, we have a big advantage in that we had a heads-up, and we kind of saw it coming."
Additionally, American hospitals are better equipped to handle a pandemic as a result of the antiterrorism training many received after 9/11. The threat of avian flu over the past 5 years also gave hospitals specific emergency strategies for influenza epidemics.
The U.S. government declared a public health emergency on April 26 as a result of an increasing number of cases of swine flu, a new type of influenza virus that contains genes from pig (swine), bird and human influenza viruses. Although the effect of the disease in the U.S. has been mild so far, swine flu is suspected of killing at least 159 people in Mexico.
Who's Vulnerable?
Many of the afflicted have been young men and women in their 30s who appeared to be very healthy.
The suspicion is "older people, older then 50, may have developed some sort of partial immunity as a result of prior exposure to a related virus," said Richard Wenzel, MD, MSc, chairman of the department of internal medicine at the Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, VA, and immediate past President of the International Society for Infectious Diseases.
"Therefore, young people are proportionally susceptible. Now, once they get infected why are young people dying? This is really a mystery. One of the possibilities is as we saw in H5N1, the Avian flu, young people have a very robust immune system, and it may be that it overreacted to the virus and actually damages the body's repair system."
Also being questioned is why only one person in the U.S. has died from swine flu when many more have died as a result of the flu in Mexico.
"If the illness presents differently in Mexico but the virus is the same that points to the host being somehow different," said Wenzel.
"Maybe Americans are more likely to have protective antibodies from other vaccines or from previous illnesses. Perhaps the high pollution levels in Mexico somehow make those living in the area more susceptible to illness. It's too soon to tell, but in the weeks to come, geographic and sociological factors may prove that Americans are less hospitable hosts."
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AOTA Announces 2009 Election Results
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The American Occupational Therapy Association's Nominating Comittee recently announced the results for the 2009 AOTA elections. The following are the results:
General Election
Florence Clark, President-Elect
Virginia "Ginny" Stoffel, Vice President
Thomas Fisher, Board Director
Coralie "Corky" Glantz, Board Director
Jyothi Gupta, Commission on Education Chairperson-Elect
Barbara Hemphill, Ethics Commission Chairperson-Elect
Michele Luther-Krug, OTA Representative to the RA
Special Interest Sections
Tara Glennon, AMSIS Chair
Leslie Jackson, EISSIS Chair
Missi Zahoransky, HCHSIS Chair
Tina Champagne, MHSIS Chair
Assembly of Student Delegates
Ryan Morgan, Chairperson
Kayla Chambers, OTA Vice Chairperson
Janelle Murray, OT Vice Chairperson
Stephen Barbour, Secretary
Elizabeth Hayes, Communications & Advocacy Chairperson
Jennifer Cruz, Representative to the Commission on Practice
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PA Passes Blue Shield Coverage for OT
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On Oct. 7 the Pennsylvania House passed HB 1177, amending an old insurance act to add several professions, including occupational therapy, to a list of providers who were now approved to participate in Blue Shield (now called Highmark) coverage. Pennsylvania Gov. Ed Rendell is expected to sign the bill shortly.
POTA legal counsel Michael Allen told ADVANCE the bill rode the coattails of the state's hard-hitting insurance reform law in autism coverage that Rendell signed July 9. That law names occupational therapists as qualified providers in autism treatment.
Considered by some as the "strongest autism insurance reform bill in the country," it virtually orders Pennsylvania insurers to accept autism claims on the same basis that they do others, and adding a claims dispute process to the law that demands that claims be paid while any dispute is in process.
The move came after a great deal of highly visible advocacy from parents of ASD children as well as their providers and interested supporters. An investigation into how much adding such coverage would cost showed that increases due to the reform would be "modest, relative to ongoing insurance cost increases; estimated cost offsets for families and the commonwealth; and better results for children and youth with ASD."
Allen said that up that point, changing the Blue Shield regulations had been an uphill battle for almost eight years. POTA has been working on it steadily for the past four years.
Pennsylvania was the first state in the country to license the Blue Cross/Blue Shield insurance companies in the earlier years of the 20th Century. The contract named the professionals whose participation should be covered, and it included both physical therapy and speech therapy, but not occupational therapy, which many considered to be part of physical therapy.
So Keystone State OTs practicing as independent contractors have never had the right to reimbursement from the original Blue Shield contact. But over the past 20 years, Blue Shield has created other insurance constructs such as HMOs, PPOs and point-of-service policies in which OTs have participated.
In 2000, however, Highmark consolidated Blue Shield and built the constructs of its new service corporation around the old law.
"Suddenly, OT claims were being denied, and no one knew why," Allen said. At first the company tried asking OTs to bill under PT, which of course they could not and would not want to do. Other ideas on how to get around the law did not work, and Highmark did not support a change in the original contract.
Now, Allen believes, Highmark will probably start to build networks of occupational therapy providers to help it meet the standards of the new autism law.
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RA Approves PTSD, 'Livable' Communities Statements
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In a special e-meeting, the online Representative Assembly voted to approve "societal statements" on post-traumatic stress disorder and "livable" communities that AOTA will use to educate legislators and third-party payers about occupational therapy's role in community health and wellness.
The assembly met online September 3 to September 15 to discuss and vote on the statements, drafted by practitioners with expertise in these two areas and finalized by the RA Coordinating Council (RACC).
It's unusual for the full assembly to meet online before its annual fall meeting, which will begin next month, but Vice Speaker Deborah Murphy-Fischer told her colleagues that the association wanted to use the statements "as soon as possible."
The Societal Statement on Combat-Related Posttraumatic Stress (PTSD) was penned by three military occupational therapists: Robinette Amaker, COL, SP, PhD, CHT, FAOTA; Yvette Woods, LTC, SP, PhD, OTR/L; and Steven M. Gerardi, LTC, SP, MS, OTR/L, CHT, at the request of the RACC.
Noting statistics from the mental health industry that say 150,000 military men and women now home from Iraq and Afghanistan currently suffer from PTSD, the statement notes its symptoms and the cost to society of not addressing them: the ongoing inability of these survivors to deal successfully with their personal and vocational lives.
The statement adds, "The overarching goal of occupational therapy for military personnel coping with combat-related PTSD is to use strategies to help them recover, compensate or adapt so they can re-engage with activities that are necessary for their daily life...Because of their knowledge and skills in addressing the physical, cognitive and psychosocial factors associated with combat-related PTSD, occupational therapists and occupational therapy assistants bring broad expertise to help personnel identify the barriers that are limiting their recovery and participation in meaningful activities. AOTA supports recognition of and intervention services for military personnel coping with combat-related PTSD, including research, advocacy, education and resource allocation consistent with professional standards and ethics."
The Societal Statement on Livable Communities, written by Lisa Ann Fagan, MS, OTR/L, chair of the Home and Community Health SIS, and Cheri Cabrera, OTR, advocates for community planning that addresses the issues of gray America and people who are handicapped in physical or cognitive abilities.
The statement emphasizes the profession's commitment to equal opportunity as being in line with a 2007 United Nations mandate that says people should have the right to choose their places of residence and have equal access to support services that promote full participation in community living.
A "livable" community, as defined by the AARP in 2005, "is one that has affordable and appropriate housing, supportive community features and services and adequate mobility options, which together facilitate personal independence and engagement of the residents in civic and social life."
The statement notes that "occupational therapy practitioners plan and implement strategies that promote their client's participation in community life by creating opportunities to establish, restore or maintain the skills used in activities of daily living and other meaningful occupations, and by supporting others who are advocating for their own and others' rights."
OT personnel advocate for such things as environmental modifications to remove barriers from homes and communities, and for supportive community services "including transportation, personal care, health care, education, employment and other services." The statement also says OT promotes public health through effective partnerships with individuals, private organizations and government agencies.
Members were able to audit the online meeting and to comment to their representatives on ongoing discussion of the topics.
To read the full text of the statements, go to http://www.aota.org/Govern/RA/EMeeting.aspx
─ E.J. Brown
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OT Licensure Bill Passes Michigan Senate 35-0
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The Michigan Occupational Therapy Association (MiOTA) found success this past Thursday, Sept. 11, when the Senate unanimously passed Bill 921 providing for licensure of occupational therapists and assistants. MiOTA will be working closely with AOTA to ensure that the bill now passes the House. Michigan AOTA members are encouraged to contact their state representatives to show support for the licensure initiative and requesting that they vote in favor of SB 921.
To read the bill in its entirety, click here.
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CMS Announces that OTs are exempt from DMEPOS Accreditation Requirements
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The Centers for Medicare & Medicaid Services (CMS) announced on September 3 that physicians and certain licensed health care professionals who supply durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) no longer need to become accredited prior to obtaining a supplier number from the National Supplier Clearinghouse (NSC). The exemption includes occupational therapists in private practice.
Eligible professionals are exempt from meeting the September 30, 2009 accreditation deadline unless CMS determines that the quality standards are specifically designed to apply to such professionals.
CMS advices any occupational therapists who have been denied an NSC supplier number due to a failure to meet the DMEPOS accreditation requirements to resubmit applications to NSC, which has been notified that certain DMEPOS suppliers are now exempt. CMS fully expects NSC to be properly processing supplier applications by September 8, 2008.
CMS will issue a fact sheet and FAQ document on its Web site by Monday, September 8, 2008.
For more information from AOTA on the ruling, click here.
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