Medicare
What are two pros to medicare?
- Wide range of covered services
- No network restrictions
- National coverage
- Supplemental options
What are 2 pros to Medicaid?
- Provides affordable healthcare access to low-income individuals
- Comprehensive coverage: Medicaid covers a wide range of medical services
- Improved health outcomes: Medicaid can help individuals manage chronic conditions, detect heath issues early, and improve their overall health
- Eligibility for vulnerable groups: children, pregnant women, and elderly with low income
What is the main purpose of this bill?
Seeks to remove barriers to the provision of occupational therapy services for someone with a mental health diagnosis under Medicare and Medicaid where these services are already allowed in benefit
What is one bill other than ours which has an impact on occupational therapy?
- Education for All Handicapped Children Act of 1975
- Any of the groups that are going in class
What is one theory we have learned about which addresses mental health?
- Allen cognitive disabilities model frame of reference
- Model of Human Occupation (MOHO),
- Person-Environment Occupation Model (PEOP)
- Recovery Model of Mental Health
- Sensory Integration FOR
- Social Cognitive/Social Learning FOR
What are 2 cons to Medicare?
- gaps in coverage
- prescription drug plans (Medicare part D plans can differ from insurer to insurer, and you need to anticipate your prescription drug needs for the year)
- copayments and deductibles
- may need referrals to see specialists
- medicare may not cover you if you live in two different places during the calendar year
What are 2 cons to Medicaid?
- Limited coverage: may not cover all medical needs
- Limited provider networks: The network of healthcare providers accepting Medicaid is often more limited than private insurance
- Physician acceptance: physicians are less likely to accept new Medicaid patients than those with Medicare or private insurance
- Paperwork and rules: there are lots of paperwork and complex rules for individuals on Medicaid
Has this bill been passed?
NO
What populations can be impacted by policy and legislation?
Trick question, ANY!!
What is one common occupational therapy assessment for mental health?
- Beck anxiety inventory (BAI)
- Beck depression inventory (BDI)
- Beck hopelessness scale (BHS)
- General self-efficacy scale (GSES)
- Geriatric Depression Scale (GDS)
- Patient Health Questionnaire (PHQ-9)
Who is eligible for medicare?
You can be eligible if you are 65 and older and paid medicare taxes while working for a certain amount of time.
- Mandatory benefits (inpatient & outpatient hospital services, physician services, lab and X-Ray services, home health services, transportation to medical care)
- Optional benefits (prescription drugs, case management, PT, OT
- Other services (dental care, well-child care, immunizations for children, mental health and substance abuse services, emergency services, medical equipment and supplies)
Who is one of the sponsors for this bill?
Senator Margaret Wood
Senator Tim Scott
What is the difference between a bill and a law
A bill is a proposal for a new law or a change to an existing law. A member of Congress, such as a representative or senator, writes a bill, which is then introduced in the Senate or the House of Representatives. Bills can be based on original ideas or suggestions from constituents, interest groups, or public officials
A law is a written bill that has been passed and signed into law. In the United States, a bill becomes law when it is signed by the President or when both houses of Congress override a presidential veto. If the President does not sign a bill and Congress adjourns, the bill is vetoed by default, which is known as a pocket veto. Congress cannot override a pocket veto
What is one mental health need OTs can assist with?
Symptoms management
Daily Routines
Life Management skills
Adapting to their environment
Regaining skills to participate in work, school, and leisure activities
Dishcharge preparedness
What does Medicare cover?
Medicare covers health care services and items that are medically necessary and reasonable.
What is one service Medicaid does not cover?
- Elective procedures (Cosmetic surgeries, non-medical weight loss procedures)
- Fertility treatments
- Non-emergency transportation (Traveling to doctors appointments)
- Long-term custodial care
- Adult dental services
- Vision services for adults
What is the impact of the bill if it is not passed?
Ambiguous guidance for Medicare and Medicaid programs can continue to deny claims for OT for mental health or substance use disorders.
How does legislation impact occupational therapy?
Legislation plays a crucial role in defining the scope of practice for OTs, dictating what services they can provide, who they can treat, and under what conditions, essentially shaping the legal framework within which occupational therapists operate and ensuring patient access to appropriate care by setting standards for practice and reimbursement across different states and healthcare systems.
*Answers may vary
OTs can provide strategies to manage anxiety through relaxation techniques, gradual exposure to social settings, and cognitive behavioral therapy (CBT) approaches
- eye exams
- long term care
- cosmetic surgery
- massage therapy
- routine physical exams
- hearing aids
Medicaid is available to who, in MO?
- Low-income children and adults
- People with low incomes and low asset levels who are aged, blind or disabled
- Adults under 65
- Infants under 1
- Children 1-18
- Pregnant women
What was the original larger bill this bill was part of?
*Hint: it is long and was an Act
Better Mental Health Care, Lower-Cost Drugs, and Extenders Act
What are the 10 steps for a bill to become a law?
* I will give the points to the closest answer
1. The bill begins
2. The bill is proposed
3. The bill is introduced
4. The bill goes to committee
5. The bill is reported
6. The bill is debated
7. The bill is voted on
8. The bill is referred to the senate
9. The bill is sent to the president
10. The bill is a law
Why are OTs qualified to address mental health needs in our clients?
* Answers may vary
Holistic approach: OTs take a holistic approach, looking at how mental issues affect a person's ability to perform daily tasks like self-care, work, and social interaction
Focus on function: Ots prioritize improving functional abilities through targeted interventions that address the underlying challenges impacting daily life
Skillset in cognitive and sensory processing
Adaptive strategies
Environmental modifications