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