Print Page   |   Contact Us   |   Sign In   |   Register
Legislative Issues and Updates
Share |

 

 

February 2019

 

NYSOTA Advocacy Day
NYSOTA Advocacy Day 2019 is set for Tuesday March 5, 2019 at Meeting Room #1 in the Empire State Plaza Convention Center, Concourse Level, in Albany.

NYSOTA’s 2018 Advocacy Day was March 14th. The day was a great success, with attendance over 350. OT and OTA programs from all over the state attended.

 

FY 2019 - 2020 NEW YORK STATE EXECUTIVE BUDGET
There are 6 proposals that NYSOTA supports:
1. A proposal to raise payments to EI providers by 5%
2. Codification of ACA health insurance benefits into state law, including protecting coverage of Pre-existing Conditions, the ACA Essential Health Benefits including rehabilitation and habilitation, and establishing the New York State of Health.
3. The creation of a Universal Access Commission to evaluate the possibility of a universal health care plan in New York.
4. $15 million more for expansion of high-quality prekindergarten for three- and four-year-old children
5. a $10 million expansion of Empire State After School grants to high-need districts
6. $1.5 million more to create enhanced mental health and school climate support grants for middle schools and junior high schools

 

PUBLIC PROTECTION AND GENERAL GOVERNMENT ARTICLE VII LEGISLATION Part CC Workers’ Compensation
This legislation amends section 13-b of the Workers’ Compensation Law regarding the authorization of providers and the definition of such providers.

The legislation provides an amendment to 13-b 1. That adds (h)

12 (h)"Occupational therapist" shall mean licensed as having a bach-
13 elor's or master's degree in occupational therapy from a registered
14 program with the education department or receipt of a diploma or degree
15 resulting from completion of not less than four years of postsecondary
16 study, which includes the professional study of occupational therapy in
17 accordance with the education law and the regulations of the commission-
18 er of education.

Unfortunately, this language does not include a recent amendment to Title VIII, Article 156 of the education law regarding the education requirements for licensing an occupational therapist. The words, “at least,” were added to address the fact that some occupational therapists are now graduating at entry level with solely a doctorate degree. The amendment proposed in the executive budget Article VII Public Protection and General Government legislation would be interpreted to exclude occupational therapists with a doctorate degree from being a provider in the Workers’ Compensation program.

The New York State Occupational Therapy Association recommends amending the proposed legislation to include the words “at least,” as follows.

12 (h)"Occupational therapist" shall mean licensed as having at least a bach-
13 elor's or master's degree in occupational therapy from a registered
14 program with the education department or receipt of a diploma or degree
15 resulting from completion of not less than four years of postsecondary
16 study, which includes the professional study of occupational therapy in
17 accordance with the education law and the regulations of the commission-
1
8 er of education.

In addition, the legislation provides a definition of “provider” in subpart (m) that lists every provider of Workers’ Compensation services except the occupational therapist. We believe this may have been a simple oversight.

12 (m) "Provider" shall mean a duly licensed acupuncturist, chiropractor,
13 independent medical examiner, nurse practitioner, physical therapist,
14 physician, physician assistant, podiatrist, psychologist, or social
15 worker authorized by the chair.

 

OT evidence of a causal relationship to a work related accident
This legislation also proposes an amendment to section 13-b of the Workers’ Compensation Law that a “record, report or opinion of a physical therapist, occupational therapist, acupuncturist or physician assistant shall not be considered as evidence of the causal relationship of any condition to a work related accident or occupational disease under this chapter. Nor may a record, report or opinion of a physical therapist, occupational therapist or acupuncturist be considered evidence of disability.”

 

 

Early Intervention

New EI Regs proposed in August addressed the conflict of interest regulation allows the evaluating therapist to also be the treating therapist unless the Early Intervention Officer intervenes by documenting that such an arrangement is not in the best interest of the child.

 

 

Conflict of Interest

Subparagraph (ii)(a) of paragraph (7) of subdivision (a) of section 69-4.11 is amended and subparagraphs(ii)(b) through (d) are repealed as follows:

[(a) For children referred to the early intervention program on or after January 1, 2013, or for children referred to the early intervention program prior to January 1, 2013 for whom an additional evaluation or partial evaluation is requested on or after January 1, 2013 for the purpose of adding a new service, neither the] The evaluator [which] who conducts an evaluation of a child [,] or an approved agency which employs or contracts with the evaluator [, nor a relative or business associate of the evaluator,] shall [provide] not be prohibited from providing early intervention services [to such child unless], authorized [by the commissioner, after consultation with the early intervention official,] by the Early Intervention official and included in the child’s individualized family service plan, unless it is documented by the Early Intervention Official that this course of action is not in the best interest of the child and family [due to special circumstances related to the evaluator's qualifications or availability or other extraordinary circumstances in which there is a clear showing that the child will not be able to access needed services absent such authorization]. Such documentation must include justification for prohibiting the evaluator from providing early intervention services to such child.

 

 

Medicaid Out-patient Visits

Last year the Executive Budget Article VII, Part A, section 5, proposed amended §365-a of the Social Services Law to raise the limit on physical therapy visits to forty per year and by removing the word “each” in this section the amendment would have reduced the visits allowed for occupational therapy and speech therapy to a combined twenty visits.

 

NYSOTA opposed this proposal and recommended an appeals process to over-ride the current 20 visit limit.

 

The Assembly Health Committee and others told NYSOTA that they were going to propose 40 visits each. But when their one-house bill came out it provided 40 for PT and a combined 40 for OT and ST.

 

The Assembly supported NYSOTA’s position re. an appeals process in 2011, but now they are saying that it would be too expensive.

 

The Senate did not include this issue in their one-house bill. In discussions with leadership they wanted to return to the current limits but had interest in some form of a limit over-ride process.

 

 The final budget decision was to give PT 40 and OT and ST would keep the 20 each.

 

Jeff Tomlinson met with officials in the Department of Health and learned that the Governor increased the PT visits in order to allow the utilization of PT services for pain management in an attempt to reduce the prescriptions of opioids.

 

The Department of Health expressed an interest in any documentation that the twenty visit limits on occupational therapy was problematic for patient outcomes.

 

 

Medicaid Therapy Visit Limit Override

S.2541 by Senator Comrie amends §365-a of the Social Services Law and allows for speech, physical or occupational therapy under the Medicaid program to provide treatment beyond twenty visits where the provider of the therapy or services attests to the medical necessity of the additional visits.

 

The bill language reads as follows, speech therapy  and occupational therapy each shall be limited to coverage of twenty visits per year; physical therapy shall be limited to coverage of  forty visits  per  year unless the professional at whose direction the therapy or services are provided or the provider of the therapy or services attests to the medical necessity of additional visits;

 

A.4846 by Assembly member Barrett amends §365-a of the Social Services Law and allows for speech, physical or occupational therapy under the Medicaid program to provide treatment beyond twenty visits where the provider of the therapy or services attests to the medical necessity of the additional visits. However, the language is different from the Comrie bill.

 

Last session by Assembly Member Barrett had no “same as” in the Senate. Introduced in Assembly Health last year on May 15th and reported out to Ways & Means May 23rd. The bill remained in Ways & Means. This bill is consistent with a Medicaid Redesign issue NYSOTA tried to address in 2011. NYSOTA issued a memo of support for this bill.

 

 

Workers’ Compensation Coverage of OTA Services
A.3753 by Assembly member Zebrowski amends the workers compensation law to allow payment for treatment services by occupational therapy assistants provided under the workers compensation program. Currently the workers compensation law only covers services by an occupational therapist. The bill will amend subdivision 1(e) of section 13-b of the workers' compensation law.

 

This legislation was passed by the Assembly in both 2017 and 2018.  Senator Savino offered, at the last week of the 2017 session to amend the bill as follows:

 

The chair, in consultation with the board's medical director,shall review occupational therapy service codes to determine the appropriateness of modifiers, if any, based on the practitioner rendering the service and shall implement modifiers as appropriate.

 

NYSOTA declined this amendment out of concern that this amendment would allow for the creation of treatment code modifiers that would lead to a different payment levels when services are provided by an occupational therapy assistant.

 

 

OT and PT Insurance Reform
S.964 by Senator Young and A. 3757 by Assembly member Gunther amends the insurance laws in New York.

 

The proposed legislation provides that no policy of group accident or group health can impose co-payments in excess of twenty percent of total reimbursement for occupational therapy and physical therapy services.

 

The bill also adds occupational therapy as a covered service under not-for-profit insurance plans.

 

The bill creates an exceptions process for out-patient visit limits.

 

The bill also reforms utilization review procedures by prohibiting health care plans from compensating utilization review agents on a percentage basis or other method which would provide a financial incentive to deny claims; prohibit a health plan from terminating or refusing to renew a contract on the basis that a provider offered or rendered medically necessary care; require utilization review agents to provide adverse determinations to both the provider and the enrollee; require utilization review agents to report to the Department of Health and Department of Insurance respectively the clinical review criteria and standards and the definition of medical necessity used under the utilization plan; require utilization review agents to report any amendments to their utilization review plan within thirty days of such amendment; allow a health care provider to request clinical review criteria and other clinical information which the health care plan might consider in its utilization review.

 

 

Co-payments for PT and OT
A.405 by Assembly Member Cahill provides that no policy of group accident, group health or group accident and health shall impose copayments for physical or occupational therapy greater than the copay for similar services provided by a physician. This bill is being pursued by the NYPTA, however, they included OT.

 

“a  policy  shall  not  impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by a physical therapist licensed under article one  hundred  thirty-six of the  education  law  or an occupational therapist licensed under article one hundred fifty-six of the education law  that  is  greater  than  the copayment  or  coinsurance  amount  imposed  on the insured for services provided to the insured for  an  office  visit  for  the  service  of  a licensed  primary  care physician or osteopath for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.”

 

 

Limited Liability Corporations
Last session by Assembly Member Peoples-Stokes and Senator LaValle, authorizes certain licensed health service professionals to form limited liability companies.

 

Eleven health professions, including NYSOTA, have joined together in a coalition called the Ad Hoc Coalition of Title VIII Health Services Professions. The coalition has drafted a bill to amend the limited liability company law, the business corporation law, the partnership law, the public health law and the education law, to allow certain licensed health professionals to form limited liability companies. The intent of the bill is to allow physicians and certain healthcare professionals to jointly own LLCs.

 

Eleven health professions, including NYSOTA, have joined together in a coalition called the Ad Hoc Coalition of Title VIII Health Services Professions. The coalition has drafted a bill to amend the limited liability company law, the business corporation law, the partnership law, the public health law and the education law, to allow certain licensed health professionals to form limited liability companies. The intent of the bill is to allow physicians and certain healthcare professionals to jointly own LLCs, LLPs, and business corporations. Those who are included are Chiropractors (Article 132), Pharmacists (Article 137), Midwives (Article 140), Podiatrists (Article 141), Optometrists (Article 143), Ophthalmic Dispensing (Article 144), Psychologists (Article 153) Social Workers (Article 154), Massage Therapists (Article 155), Occupational Therapy (Article 156).

 

 

Opioid Treatment Bill
The lobbyist for the chiropractors has drafted an opioid alternative treatment bill that would include OT. NYSOTA has signed on.

 

Title 5-B. DISPENSING OF OPIOIDS AND ALTERNATIVE TREATMENT OF PAIN

 

9. (a) When a patient seeks treatment for any of the conditions that cause pain, a practitioner shall refer, discuss and/or prescribe any of the following nonpharmacological treatment alternatives, based on the practitioner’s clinical judgment and following generally accepted national professional or treatment guidelines, before starting a patient on an opioid: acupuncture, chiropractic, massage therapy, physical therapy or occupational therapy.

(b) This article shall not apply to the use of opioids for patients being treated under any of the following circumstances: treatment of cancer; hospice care; medical treatment in a long-term care facility; post-surgery treatment immediately following a surgical procedure; or in a medical emergency situation. For purposes of this article, a “medical emergency situation” shall mean an acute injury or illness that poses an immediate risk to a person’s life or long-term health.

 

 

Elder Abuse
On August 1, 2018 Governor Andrew M. Cuomo announced $8.4 million in state and federal funding to improve and expand services for vulnerable adults at risk of abuse, neglect or financial exploitation. Developed by the state Office of Victim Services and state Office for the Aging, the Elder Abuse Interventions and Enhanced Multidisciplinary Teams Initiative is the first of its kind in the nation. The initiative will fund and support 23 existing multidisciplinary teams currently targeting elder abuse and establish additional teams with the goal of serving every county in the state by the fall of 2020.

 

For more information go to www.stopelderabuseny.com

 

 NYSOTA has supported state legislation that addressed elder abuse.

 

 

 

Jeffrey Tomlinson,OTR, MSW, FAOTA

Legislative & Government Relations Coordinator
legislation@nysota.org

Association Management Software Powered by YourMembership  ::  Legal