Opportunities for Occupational Therapy Behavioral Health: A Call to Action

Virginia C. Stoffel, PhD, OT, BCMH, FAOTA, is President-Elect, American Occupational Therapy Association, and Associate Professor, Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, PO Box 413, Milwaukee, WI 53201; stoffelv@uwm.edu The Patient Protection and Affordable Care Act of 2010 (ACA; Pub. L. 111– 148) provides a window of opportunity for occupational therapy to reengage in serving people with serious mental illness (SMI) and substance use challenges using contemporary community-based and personcentered, recovery-oriented services and supports. As implementation of the law moves forward, occupational therapy practitionersmust respond to this call for action to ensure that the essential benefits in products offered by state-based purchasing exchanges fully include rehabilitation, habilitation, mental health, substance abuse, and behavioral treatment services for all covered persons with behavioral health conditions. Eachbenefit category is required to be covered under the exchange-based offerings. Occupational therapy’s goal must be that occupational therapy is recognized in all of them. In addition, availability of chronic care management and care coordination services for people with SMI and disabling substance use disorders provide additional areas in which occupational therapy expertise can add to the consistency and quality of recovery outcomes. Medication management and wellness and prevention programs are consistent with areas covered by the ACA and with recovery-oriented outcomes. With the growing movement toward recovery and the emerging definitions of recovery, recovery services, and recovery supports, the goodness of fit between these constructs and the unique skills of occupational therapy practitioners supports a growing role for occupational therapy in the behavioral health marketplace. The June 28, 2012, U.S. Supreme Court decision concerning constitutional challenges to the ACA (National Federation of Independent Business, et al. v. Sebelius, Secretary of Health and Human Services, et al., 567 U.S. 2012, Case No. 11–393) and the recent presidential election outcome bode well for optimum implementation of the law. The Supreme Court upheld the minimum coverage provision (the “individual mandate”) considered central to the law. By a 6 to 3 vote, the justices found that the individual mandate was permissible under the power of Congress’s tax authority. Other provisions, such as providing family coverage for children up to age 26, coverage of preexisting conditions, and the strengthening of health centers in urban and rural communities across the nation, remain in force. Although the Supreme Court decision on the 2014 Medicaid expansion kept the expansion program intact, federal penalties for states choosing not to undertake the Medicaid expansion were removed, essentially making this expansion an option for states (Manderscheid, 2012). Although the political process will continue around response to the Medicaid expansion, at this time, 26 states have indicated some opposition to the expansion. The major implication of this action is that people who are currently uninsured in states rejecting the expansion may remain Virginia C. Stoffel, PhD, OT, BCMH, FAOTA