Bill Overview
Title: Occupational Therapy Mental Health Parity Act
Description: This bill requires the Centers for Medicare & Medicaid Services (CMS) to conduct outreach on Medicare coverage of occupational therapy services to treat substance use or mental health disorders. The CMS must also issue guidance on the availability of such services under Medicaid.
Sponsors: Sen. Hassan, Margaret Wood [D-NH]
Target Audience
Population: People with mental health or substance use disorders
Estimated Size: 30000000
- The legislation aims at improving outreach and guidance regarding mental health and substance use treatment under Medicare and Medicaid.
- There are millions of individuals enrolled in Medicare, which includes older adults (typically those aged 65 and older) and some younger people with disabilities.
- Medicaid covers low-income individuals and families, which includes a wide range of demographics, such as children, elderly, pregnant women, and people with disabilities.
- Substance use and mental health disorders are prevalent across all age groups worldwide, affecting hundreds of millions of people.
- Enhanced coverage and outreach may improve access to occupational therapy for individuals with mental health and substance use disorders.
Reasoning
- The population affected by this policy includes primarily people who are enrolled in Medicare or Medicaid and have mental health or substance use disorders. This will extend across diverse age groups, indicating a broad spectrum of individuals from the elderly to younger adults with disabilities, as well as low-income populations, which could include children and pregnant women.
- Given the budget limitations, we must consider that while the policy aims to help millions, its outreach and direct impact will initially be targeted towards educating Medicare and Medicaid users about the new provisions, with further effects seen over the 20-year horizon as awareness and systematic changes slowly take root.
- The feedback from our simulated interviews should reflect both the immediate impact (lower impact for some with gradual changes) and longer-term improvements in wellbeing as services become more accessible.
- The Cantril wellbeing scale helps to account for overall life satisfaction, which the improved mental health services should influence positively but not drastically overnight due to the incremental nature of policy implementation.
Simulated Interviews
Retired teacher (Florida)
Age: 70 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- I'm relieved to hear that there might be more support for mental health services under Medicare. I've struggled with anxiety, and knowing that occupational therapy could be covered is comforting.
- I hope that more guidance and information will make it easier for people like me to access this therapy without a struggle.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 8 | 5 |
Tech support specialist (California)
Age: 34 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- Occupational therapy has been recommended to me, but I've hesitated due to cost concerns. This policy might make it more accessible and affordable.
- I hope that the increased outreach includes clear information on how to get started with these services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 9 | 6 |
Freelance writer (New York)
Age: 28 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 6/20
Statement of Opinion:
- I'm hopeful that this new policy will allow me better access to occupational therapy without financial stress.
- However, I'm worried about how long it might take for these changes to be effectively communicated and implemented.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Construction worker (Texas)
Age: 52 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I think occupational therapy could help me with both physical and mental issues, but it's been out of reach.
- It's good to know that Medicaid might now cover these services more extensively, which could help me manage pain better.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 8 | 5 |
Retired social worker (Ohio)
Age: 62 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 2/20
Statement of Opinion:
- I had limited access to mental health therapies before, knowing that occupational therapy might be covered is a huge relief.
- I most appreciate that there will be more informational outreach about these services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 6 | 3 |
| Year 10 | 7 | 4 |
| Year 20 | 8 | 4 |
Small business owner (Illinois)
Age: 45 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 3/20
Statement of Opinion:
- I don't think this policy applies to me directly, as I'm not on Medicare or Medicaid.
- It does seem beneficial for those who need it, though.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Stay-at-home parent (Maine)
Age: 30 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 4/20
Statement of Opinion:
- Improved access to occupational therapy sounds great, especially when dealing with postpartum problems.
- I'm hopeful for more comprehensive care options through Medicaid.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Retired engineer (Arizona)
Age: 79 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 3/20
Statement of Opinion:
- Access to more focused therapy like occupational therapy under Medicare might help me cope better with my grief.
- It’s good to know that there should be more awareness about these options soon.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 4 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
College student (Oregon)
Age: 22 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 2/20
Statement of Opinion:
- The policy's focus on improved awareness and coverage is a step forward in making needed therapies accessible, which can be invaluable in recovery.
- Hope they provide clear guides on how students like me with limited income but without Medicaid can leverage such services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Part-time librarian (Michigan)
Age: 55 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I'm hopeful that, should my Medicaid application go through, this new policy will make it easier to access occupational therapy for my anxiety.
- The outreach part is essential, as navigating these systems has been a challenge for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Cost Estimates
Year 1: $25000000 (Low: $20000000, High: $30000000)
Year 2: $25000000 (Low: $20000000, High: $30000000)
Year 3: $25000000 (Low: $20000000, High: $30000000)
Year 5: $25000000 (Low: $20000000, High: $30000000)
Year 10: $25000000 (Low: $20000000, High: $30000000)
Year 100: $25000000 (Low: $20000000, High: $30000000)
Key Considerations
- The policy aligns with ongoing national strategies to improve mental health and substance use disorder treatments.
- While the outreach is crucial, the actual uptake and conversion to improved therapeutic outcomes depend on the implementation effectiveness.
- Some costs will also depend on the coordination with state health agencies and adaptation of CMS guidelines to various local contexts.