ILOTA Communique 2019 Second Quarter | Page 14

Spotlight Monika Robinson DrOT, OTR/L New Legislation & Emerging Practices Impacting Home and Community Health Practices Many new potential changes are in store for our professional practice in the community! There are exciting developments from recent legislation at the Federal and State level in addition to new evidence informed practices that affect the landscape of services within the home and community. These changes impact our clients across the lifespan from new practices that use telehealth coaching models for early intervention services (Little, Pope, Wallisch & Dunn, 2018) to the implementation of the Center for Medicare & Medicaid Services’ (CMS) innovation program known as the Community Aging in Place—Advancing Better Living for Elders (CAPABLE; Szanton, et. al., 2018) that assists older adults to remain in the community. Other CMS innovation models that could implement occupational therapy practices within the community are the Accountable Communities of Health (ACH; CMS, 2019) and Independence at Home Models (2019). As a start, recent Federal and State legislation has attempted to increase access to occupational therapy services for various populations within the community. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (SUPPORT; 2018) specifically identifies occupational therapy practitioners to provide services that are non-pharmaceutical for individuals with substance use disorder. Through the recent passing of the Bipartisan Budget Act (2018), there will be an expansion of Medicare Advantage plan services to include non-medical benefits that address the social determinants of health. Examples of some potential services that will assist individuals with chronic conditions are the provision of meals that will emphasize proper nutrition, mediation of medications, telehealth services and ADL & IADL function within the home and community through the reimbursement of home modifications, caregiver supports and transportation services. Recent efforts have been made at the Federal level to identify occupational therapy practitioners as providers of telehealth services through CMS via the expansion of Medicare telehealth services. Unfortunately, just prior to its passing, the inclusion of therapy practitioners was excluded but AOTA is monitoring the Congressional Telehealth Caucus drafting new legislation around April of this year (2018). Here in Illinois, the Telehealth Act (2018) recognizes occupational therapy practitioners as providers of telehealth services. Evidenced informed telehealth practices support the role for occupational therapy practitioners to provide telehealth services for individuals of all ages, particularly those that have limited access to services. Telehealth services are cost effective and efficacious as proven through large models of service delivery such as the Veterans Health Administration (Department of Veterans Affairs, n.d.). In addition to the aforementioned application of telehealth services for early intervention (Little, Pope, Wallisch & Dunn, 2018), telehealth and other forms of technology services have been applied to deliver remote assessments of wheelchair and seating needs for adults and children (Graham, Boland, Grainger & Wallace, 2019), treatment interventions for individuals with Alzheimer’s (Cotelli, et al, 2017), stroke (Chumbler, et. al, Continued on Page 15 Page 14