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Legislative Nook Jan 2015

We welcome input and additional volunteers to gather, interpret and advocate for legislative information at our State level that impacts us all as OT Practitioners.

Information has been gathered from the AOTA website and summarized here. If you would like additional information and details, we encourage you to visit AOTA’s website and find the legislative information under the sites’ Advocacy and Policy tab.

Posted 7/2014, aota.org: CMS released a bulletin that addresses Medicaid services for children with Autism, prospective treatment avenues including OT’s and “Other Licensed Practitioner Services” categories as a source for individuals to understand services available for children who are treated for the Autism Spectrum Disorder (ASD). Please visit the following website for a clear picture of what the bulletin entails: “Medicaid.gov under Federal Policy Guidance at http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdf.” (AOTA.org, retrieved January 13, 2015).

Backlocked payments for services as being reviewed by the Recovery Audit Program by Recovery Audit Contractors is ongoing (2014-2015). AOTA suggests that AOTA members seeking additional information about existing appeals for claims being reviewed contact: regulatoryaffairs@aota.org.

Habilitation and rehabilitation services considered as part of the Essential Benefits package of the Affordable Care Act is considered a step toward victory in line with AOTA goals. Monitoring the efficacy and availability of habilitation and rehabilitation services as part of insurance benefits actually provided is another challenge in itself. An analysis of insurance benefits and policies revealed the following which I have quoted, rather than attempted to summarize: “Because habilitative services were often excluded from health insurance coverage in the past, many benchmark plans did not reference them. In those cases, states were permitted to define coverage requirements for habilitation. In cases where states did not do so, insurers have to supplement benchmark plans to include coverage of habilitative services. The ACA requires all nongrandfathered individual and small group market plans to cover the EHBs….” (Information gathered directly from AOTA website, tab: Healthcare Reform Implementation, Essential Health Benefits column, 2014).

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