April / May / June • Issue 2 • 2019
New Legislation & Emerging Practices Impact, continued from Page 14
2012; Chen et. al., 2015; Morales-Vidal & Ruland,
2013), multiple sclerosis (Yeroushalmi, Maloni,
Costello, K & Wallin, 2019), and home assessments for
individuals with cognitive and/or physical disabilities, as
well as pre-discharge assessments (Ninnis et. al, 2019).
Lastly, another potential opportunity for growing
practices can be found in the CMS Innovation Models.
These innovations are the result of the Affordable Care
Act to offer new payment and service delivery models
under CMS (CMS, n.d.). The CAPABLE Innovative
Model protocol uses an RN, OT, and handyman to
assist older adults with frail health status to remain in
the community (Szanton, et. al., 2018). The model has
been proven to be a low-cost and effective intervention
in increasing independence, reducing depression levels
and hospital re-admission rates (Szanton, et. al., 2018).
A few sites in Illinois have begun (Northwest Housing
Partnership, 2018) and mores site will be implementing
the program this year. The Independence at Home
(IAH) Innovative Model (CMS, 2019a) provides
primary care services within the home to patients who
meet eligibility requirements, one of which is that the
patient experiences limitations with two ADL’s. At this
time, there are no covered OT services and there are no
IAH models in Illinois. Fortunately, the model has been
extended past its original project completion date and
location sites will be expanded, a perfect opportunity for
the OT profession to provide home OT services under
a primary care model. Being that OT provides services
in out-patient primary clinics, it seems like a natural fit
for these same types of services to be provided in the
patient’s actual home. In order for this to occur, there
will need to be a push for the inclusion of OT services at
the Federal level.
Another potential opportunity for increased OT
services in the community under CMS’ Innovative
Models is the ACH model (CMS, 2019b). This model
strengthens the relationship and coordination of care
between the patient’s medical home and the local
community. As a result, community-based organizations
providing health and human services are more closely
linked to delivering services that focus on social
determinants of health while the patient’s medical home
continues to provide medical care services. Both entities
are incentivized to provide holistic and coordinated care
in order to receive higher reimbursement rates based on
better outcomes. It has already been proven that when
there is a higher spend on occupational therapy services
in the hospital, there is an associated effect of lower
readmission rate (Rogers, Bai, Lavin, Anderson, 2017),
just imagine what could occur if this spend was extended
into community-based services!
In conclusion, what lies ahead for occupational
therapy services is the need for continued advocacy
at the Federal and State levels to administer services
within the community. As more healthcare delivery
models are transitioning out of medical institutions and
greater focus is being given to the social determinants
of health, community-based organizations and services
are recognized as having a direct impact on one’s health
and well-being. These same social determinant of health
should be considered as part of the person’s environment
and as a profession, we are one of the leading professions
that can adequately address a good “person-environment
fit” for our clients within the community.
References
American Occupational Therapy Association (April
18, 2019). CMS fails to cover therapy telehealth services
in final Medicare Advantage Rule; AOTA to pursue
legislative solution. Retrieved from https://www.aota.
org/Advocacy-Policy/Congressional-Affairs/Legislative-
Issues-Update/2019/CMS-MA-Rule-Fails-To-Cover-
Therapy-Telehealth.aspx
Bipartisan Budget Act of 2018, Pub. L. No. 115-123,
§50322 & § 50323, 132 Stat. 201 (2018). Retrieved
from
https://www.congress.gov/115/plaws/publ123/
PLAW-115publ123.pdf
Chen, J., Jin, W., Zhang, X. X., Xu, W., Liu, X. N.,
& Ren, C. C. (2015). Telerehabilitation Approaches for
Stroke Patients: Systematic Review and Meta-analysis
of Randomized Controlled Trials. Journal of Stroke and
Cerebrovascular Diseases. W.B. Saunders. https://doi.
org/10.1016/j.jstrokecerebrovasdis.2015.09.014
Chumbler, N. R., Quigley, P., Li, X., Morey, M.,
Rose, D., Sanford, J., … Hoenig, H. (2012). Effects
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