1. What’s new Mary Hennigan, OTR, MBA November 7, 2014 1

2. Mental Health “One pager” Carrying legislation, 2015 Testimony David Lakey, MD Commissioner of Department of Services regarding the mental health workforce shortage and OT’s role in mental health, August 27, 2014 Bridgett Piernik-Yoder, PhD, OTR testified at the House Select Committee of Health Education and Training, August 28, 2014 regarding education and training of occupational therapists Robin Clearman, OTR testified at the House Select Committee of Health Education and Training, September 16, 2014 regarding occupational therapy’s role in mental health. 2

3. Mental Health testimony Robin Clearman, OTR testified at the House Select Committee of Health Education and Training, September 16, 2014 regarding occupational therapy’s role in mental health. Shirley Wells, Dr.P.H., OTR testified at the County Affairs Committee, October 27, 2014 regarding occupational therapy’s role in mental health. 3

4. Scope of Practice Modern Healthcare meeting in Dallas May, 2014. Panelists included Joel Allison, CEO, Baylor Scott & White Health, Dr. Nancy Dickey, Professor, Texas A&M University, President Emeritus, Texas A&M University Health Science Center and Edward Salsberg, Professor, George Washington University School of Public Health and Health Services. During their presentations they referred to the necessary scope of practice changes that will be required to implement the Affordable Care Act. Additionally they referred to Texas 1115 Health Care Transformation Waiver and super aides (high school graduates with on the job training) as primary care providers in the home. 4

5. Meetings Texas Medicaid Therapy Stakeholder Meeting March 3, 2014 Prior Authorization Listening Session June 26, 2014 Texas Health and Human Services Commission public hearing regarding Medicaid rates August 21, 2014 Texas Board of Occupational Therapy Examiners Meeting September 5, 2014 5

6. Splints Communication from therapists working with Palmetto GBA, a fiscal intermediary of the Centers for Medicare and Medicaid (CMS). Palmetto GBA is denying charges from OTs fabricating "custom orthosis" (splints) because the OT does not have an orthotist license. This is an erroneous interpretation of the Orthotists and Prosthetists Act. The regulation of Orthotists and Prosthetists specifically excludes OTs. 6

7. Splints "This chapter does not restrict a person who holds a license issued by another state agency from performing health care services within the scope of the license holder's applicable licensing act if the license holder: (1) practices in conformance with the applicable laws and rules relating to the person's license; and (2) does not: (A) violate Section 605.251; (B) represent to others that the license holder practices orthotics or prosthetics; or (C) use the terms "prosthetist," "prosthesis," "prosthetic," "artificial limb," "orthotist," "orthosis," "orthotic," or "brace" or the letters "LP," "LPA," "LO," "LOA," "LPO," or "LPOA" or any derivative of those terms or letters in connection with the license holder's name or practice. (V.A.C.S. Art. 8920, Sec. 21(a).) TOTA has been actively protecting your ability to make splints for several years. We posted information on the web site for therapists to use when dealing with splint denials. 7

8. Productivity and supervision (combatting fraud and abuse) Responded to numerous e-mails from staff of the Data Analytics and Fraud Detection Division, Office of Inspector General, Health and Human Services Commission regarding OTA supervision, numbers of hours therapists work, etc. Sent supporting TBOTE and AOTA documentation. 8

9. Code 97535 Numerous e-mails with staff of HHSC regarding Code 97535. The code has been approved for OT utilization. CPT code 97535 is self-care/home- management training (such as ADL and compensatory training, meal preparation, safety procedures, and instructions in the use of assistive technology devices/adaptive equipment) with direct, one-on-one contact by the provider, each 15 minutes. 9

10. TMHP-Texas Medicaid and Healthcare Partners TMHP is a group of contractors under the leadership of Accenture. Accenture administers Texas Medicaid and other state health-care programs on behalf of the Texas Health and Human Services Commission 10

11. TMHP Rule Making Home services not permitted at day care centers. CCP Comprehensive Care Program, Acute and Home Health High frequency-3> a week-rapidly changing, potential for rapid progress or rapid decline, plan of care requires frequent modification, client requires high frequency of intervention for limited duration (60 days or less) Moderate frequency-2 times per week, client is making functional progress, critical period to restore function or at risk of regression, plan needs to adjusted weekly or more often than weekly, complex needs require on- going education 11

12. TMHP Rule Making Low frequency-one time per week or every other week, progress has slowed, plan needs to be adjusted weekly, condition is stable plan changes slowly Maintenance-every other week to monthly, progress as slowed or stopped, ongoing therapy required to maintain, limited progress Discharge-goals achieved, therapy no longer produces functional, measurable outcome, patient declines, unable to progress, no benefit 4 units per day per therapy unless appealed 12

13. Questions? 13