Advocacy Information

DHHS Messsage on Hurricane Florence and Medicaid


Sep 13, 2018

Today, the North Carolina Department of Health and Human Services announced broad efforts to work with federal and county partners to provide additional flexibility to people enrolled in the Medicaid program and their health care providers during and after Hurricane Florence.
"Our highest priority is keeping people safe and healthy,” said DHHS Secretary Mandy Cohen, M.D. “We are doing everything possible to help those impacted by Hurricane Florence to continue to get the care and services they need without disruption.”
“We are immediately exercising existing authority and seeking additional authority to help minimize the impact of this disaster on people in Medicaid,” said Deputy Secretary for Medicaid Dave Richard. “We want to make it easier for people to access care, easier for doctors to provide that care, and to give our beneficiaries as much support as possible.”
To help make sure that people who are eligible for Medicaid continue to be able to enroll in the program and access services quickly, DHHS will temporarily allow self-attestation for most eligibility criteria for those impacted by the hurricane if documentation is not available. DHHS will also temporarily extend redetermination timelines for current enrollees to help prevent lapses in coverage due to the hurricane.
To help ensure a sufficient number of providers are available to serve Medicaid enrollees, DHHS is seeking temporary authority to waive some provider enrollment requirements, to waiver revalidation of providers who are impacted by the disaster, and to allow physicians and other health care professionals with out-of-state licenses to enroll and provide services. DHHS will also be seeking authority to make it easier to redirect individuals to alternative care locations when needed.
NC Medicaid will also support beneficiaries if they need additional units of service, medical supplies, specialized equipment or oral supplements to remain safe during the hurricane. DHHS is working with the Centers for Medicare and Medicaid Services to ensure that providers will be reimbursed for the services that they have provided even if it exceeds the beneficiary’s current authorization. DHHS is also working with CMS to retain additional flexibility as needed to support these beneficiaries in the most impacted areas of our state.
For more information regarding Hurricane Florence, please visit Those with non-emergency questions or concerns related to the hurricane should call 2-1-1 or visit 





Quality Payment Program 

August 2018

On July 12, 2018, CMS released a notice of proposed rulemaking (NPRM) detailing proposed changes to the Quality Payment Program (QPP), including the expansion of eligible clinician types to include occupational therapist. 

General information on the Quality Payment System: The QPP was established by Congress in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.  The QPP contains two tracks clinicians can choose to participate: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).  Initially, the clinician types that were eligible for the first two years of participation (2017 and 2018) included physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.  For the 2019 performance year, CMS is proposing to add Occupational Therapists and other disciplines for the definition of "eligible clinician."  Public comments on the proposed rules are due no later than September 10, 2018.

Clinicians or groups who are eligible to participate in MIPS are scored based on their performance in four categories: quality, cost, improvement activities, and promoting interoperability.  

To view the CY 2019 Physician Fee Schedule proposed rule

For a fact sheet on the CY 2019 Quality Payment Program proposed rule





NCBOT OTA Supervision Changes

July 2018

As of July 1st 2018, NCBOT has officially changed the supervision requirements for OTAs. Historically close supervision has been required for OTA's during their first year of practice. The Board now requires general supervision for all levels of OTA practice, including entry level. However, practitioners remain responsible for maintaining standards of practice as outlined in our Code of Ethics including ensuring safe and effective service delivery of occupational therapy services and fostering professional competence and development. 
The new rules can be found here


House Bill 967-Telemedicine Policy

Legislative Update 



Update on Telemedicine Policy Bill:
House 967 Telemedicine Policy:  This bill started out as a bill to expand opportunities in the area of telehealth for providers listed in Chapter 90 of the North Carolina General Statutes, like occupational therapists.  The bill, however, was changed to a study bill before being adopted by the House of Representatives.  The Senate did not vote on HB 967 before adjourning.  NCOTA plans to closely monitor the progress of telehealth initiatives and advocate for expanded telehealth opportunities for occupational therapists.   
Update on Medicaid Transformation:
House Bill 156 Medicaid PHP Licensure and Transformation Modifications:  This bill, adopted by the General Assembly, puts in statute elements of the Medicaid transformation plan championed by the North Carolina Department of Health and Human Services.  The proposed transformation plan will bring physical health services into a capitated managed care approach similar to the current MCO model. House Bill 156 requires the Department of Health and Human Services to submit a report by October 1, 2018, to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice containing proposed additional needed legislative changes and sets forth a time frame within which the Department of Health and Human Services must issue requests for proposals.


House Bill 403 Medicaid and Behavioral Health Modifications:  This bill, adopted by the General Assembly, sets in motion the development of the tailored plans, an integral part of the Medicaid Transformation plan developed by the Department of Health and Human Services. Details on the implementation of tailored plans can be found in the implementation plan link below.  


Department of Health and Human Services Implementation Plan for Tailored Plans


Pursuant to House Bill 403, the North Carolina Department of Health and Human Services issued this Implementation Plan for Behavioral Health and Individuals with Developmental Disabilities Tailored Plans to the NC Joint Legislative Oversight Committee on Medicaid and NC Health Choice on June 22. 




Advocacy Update

This is a website that is helpful with finding out proposed plans, policies, manuals and public comments regarding Medicaid Managed Care. This link includes DHHS Medicaid Managed Care policy papers focused on specific subjects in relation to the proposed Medicaid and NC Health Choice care program designs. Topics include:

Supporting provider transitions

Prepaid Health Plans

Behavioral Health and IDD Plans

Clinical Coverage policies

And others

[email protected] is an email that is helpful for any questions




AOTA's Message Regarding OTA Payment Changes in Budget Bill

Click here to read the official statement


Our advocacy is working!


On February 9, 2018, the president signed into law a bill that repeals the cap on Medicare part B outpatient therapy services; this has been 20 years in waiting! This therapy cap created significant barriers for our client’s with chronic, long-term conditions and clients that required ongoing services.  This cap previously caused many of our clients financial hardships for paying out of pocket after meeting their cap or if they could not afford services possibly permanent and debilitating injuries. We can now treat based on Medical Necessity!


 AOTA President, Amy Lamb issues a public statement:


January 11, 2018

Capitol Hill

A cap on Medicare outpatient therapy services went into effect on January 1st after Congress failed to act at the end of 2017. This $2,010 cap for occupational therapy services applies to all patients being reimbursed for outpatient, Part B therapy services, except for those provided at Hospital Outpatient Departments/Clinics (HOPD). The law applying the cap to HOPDs expired December 31, 2017. The Medicare therapy cap will in many cases deny access to medically necessary occupational therapy services for the most vulnerable Medicare beneficiaries

Please contact your Members of Congress to end the cap once and for all, and to provide a pathway to therapy services for all Medicare beneficiaries.

Last year, Congress drafted bi-partisan legislation to permanently repeal the therapy cap and replace it with a targeted review of claims.  However, the exceptions process expired at the end of 2017, and Congress failed to enact any legislation that would keep the cap from taking effect in 2018.  Congress must take action soon to prevent beneficiaries from hitting the cap and to end this policy.


Advocacy Success!

We are thrilled to announce that House Bill 208 Occupational Therapy/Choice of Provider passed the Senate today with a unanimous vote!  It will now be sent to the Governor for his signature.  NCOTA expresses our sincere gratitude to the outstanding House sponsors Rep. Hugh Blackwell, Rep. Gregory Murphy, Rep. Mitchell Setzer and Rep. Pat Hurley.  We also thank the sponsors of the Senate companion bill Sen. Paul Newton and Sen. Joyce Krawiec.   

Ashley Perkinson, NCOTA Lobbyist 

Thank you Ashley!


A special thanks goes to Representative Hugh Blackwell who presented the bill to the full House and received a strong vote of 115 to 3. Thank you Representative Blackwell!






And to Senator Paul Newton who presented the bill to the full Senate and received a vote of 47 to 0.  Thank you Senator Newton!



Advocacy Spotlight - Champions for Occupational Therapy

The 2017-2018 Session has been very active and positive for occupational therapy.  We would like to highlight the efforts of the Senators and Representatives who support OT, as well as encourage your own advocacy efforts for the profession and the clients we serve.


The State Affairs Group is responsible for all of AOTA's state legislative and regulatory activities. 

This department monitors and provides analysis of proposed legislation and regulations affecting occupational therapy in the states, conducts outreach, and provides assistance to state occupational therapy associations on key state issues such as professional regulation and scope of practice. 

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