Occupational therapists and therapy assistants made some gains with the House passage of the amended Senate bill for health insurance reform March 21, but a proposal to give OTs the right to open cases in Medicare Part A home care when OT was included in the referral was not part of the package.

That provision had been included in the original House bill passed last fall, but it was not inserted into the Senate bill that the House passed Sunday on a 219-vote plurality to make health insurance reform the law of the land.

The new law does, however, extend the therapy cap exceptions process until the end of this year, include both rehabilitative and habilitative services as required categories in the mandatory benefits package under the new system, and offer greater patient access to care with the elimination of discrimination based on health status and pre-existing conditions. That will become illegal as soon as the law is passed.

AOTA is currently analyzing the new law to examine other ways in which it will affect occupational therapy practitioners.

The package also includes guaranteed issue and renewal requirements, eliminates rescission of benefits except in the cases of fraud or misrepresentation, and eliminates annual and lifetime caps on coverage.

President Obama is expected to sign the bill into law on March 23. After that, however, it's anyone's guess as to what will happen when the Senate takes up a reconciliation debate on the amendments made to its original bill during the House process. If anything is changed in the bill, it would have to go back to the House for approval. No Republicans voted for the bill Sunday night, claiming it was unaffordable, unworkable and put at risk longstanding federal rules that prohibit the use of public monies in funding abortion.

 The GOP is expected to challenge, in the Senate, the legality of the process by which the House passed the measure. Also Republican attorneys general in at lest 13 states have already filed federal lawsuits claiming that federal lawmakers cannot constitutionally pass a law that requires residents of any states to buy something - in this case, health insurance - which the new law does. Car insurance, for instance, is regulated by state, not by the federal government. Other Constitution experts, however, say that requiring health insurance of its citizens is well within the federal government's power.

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