Thursday, January 31, 2013

The Effect of the Affordable Care Act on Music Therapy: A Call for Advocacy

A call for Advocacy

Advocacy --> Recognition --> Access

Since 2005, the American Music Therapy Association and the Certification Board for Music Therapists have collaborated on a State Recognition Operational Plan. The primary purpose of this plan is to get music therapy and our MT-BC credential recognized by individual states so that citizens can more easily access our services. The AMTA Government Relations staff and CBMT Regulatory Affairs staff provide guidance and technical support to state task forces throughout the country as they work towards state recognition. To date, their work has resulted in over 35 active state task forces, 2 licensure bills passed in 2011, 1 licensure bill passed in 2012, and an estimated 7 bills being filed in 2013 that seek to create either title protection or a licensure for music therapy. This month, our focus is on YOU and on getting you excited about advocacy.

For the last three months, I have been focused on the Affordable Care Act and how it might affect music therapy. In order to humanize our discussion I want to relate an experience about music therapy advocacy in our area.  

There is an agency in our town in Virginia which has a weekly program that invites families with children on the autism spectrum to come together for networking, sharing and learning.  This program employs a respite care model where the children who have ASD are involved in recreational therapy, physical therapy and music therapy while the parents gather to learn and network with one another.  In the fall, two music therapy students doing their practicum assignments were part of the music therapy services offered to the children.

The music therapy was so effective and popular that the music therapy students were asked to be the highlight of a presentation for a media event sponsored by a future US Senator and his wife.  This event put a spotlight on the music therapy groups offered by the program and was widely hailed as a superb success!  In fact, the two music therapy students who demonstrated music therapy services at the event were so well received that they were offered future jobs at the agency after they graduated! Currently, these same students volunteer their time at the same program so that this agency can continue to offer some level of music therapy type activities.  

This was a great success story, but how can we make it easier for agencies to employ music therapists?  Everyone at this agency was pleased with music therapy and wants to continue offering the service, but how can we make funding programs like this easier and more accessible.  Will the Affordable Care Act impact opportunities for music therapy?  How can music therapy receive more reimbursement through health care dollars?     

Let's dig in...

Please catch up on the background stories if you have missed Part I and Part Ia of this series.

Part II is a look at what the effects of Obamacare (Full text version of law is here.) might be on access to music therapy services.  I hope that you will contribute to this post and the discussion as we explore this together.  Before I go any further, I should warn you that many of the opinions linked to in this post, as well as my own conclusions, are educated guesses about what might occur.  As we discussed in Part I, many parts of Obamacare have yet to be implemented, and to further muddy the waters, the Department of Health and Human Services has only recently begun releasing detailed regulations regarding the plan.  I also remind you that the ACA as conceived by President Obama and the congress at the time is not the same plan being implemented as result of the Supreme Court ruling in 2012.  (I will discuss the ramifications of all this in Part III.)  

Music therapy is not specifically mentioned in the ACA, but access to music therapy through insurance and medical facilities may be affected as a result to changes in funding and coverage.  While there have been some isolated success stories in obtaining third party coverage through private insurance companies for music therapy services, music therapy is generally paid for through private pay or as an included service during in-patient care, rehabilitation or hospice services.  Reimbursement through private insurance companies varies by state, company, and even by case manager.  Some people don't see an improvement in this situation and the ACA may even make things worse.  Perhaps you have a different perspective? 

At least in the beginning, Obamacare will establish state or federal run insurance exchanges or companies that will provide insurance for those who cannot obtain insurance through their employment.  (Note:  As of today, only 18 states have said they will set up insurance exchanges.  The other states have left it up to the federal government or have asked only to be a partner in the process.  These exchanges are supposed to be up and running by October 2013.)  More people will gain coverage, but for the person trying to file for third party reimbursement, it means learning about one more of 50 new state sponsored programs and new kinds of bureaucracy!  So the lack of standardization may be a real hindrance to improving reimbursement rates for music therapy.  

Sometimes music therapy has been included in billing to Medicare as part of an array of services offered in skilled nursing and rehabilitation facilities.  This money is usually a fringe benefit for facilities that include music therapy and is not used to pay outright for the music therapy personnel.  There will not be a boost to this funding, and in fact, Medicare payments to facilities and physicians may face cuts since the ACA cuts $716 billion from Medicare.  There is an Independant Advisory Payment Board (IPAB) tasked with finding ways to make these cuts.  We will just have to wait and see what happens with this.        

Obamacare also attempts to significantly increase funding for low-income  individuals and families through Medicaid.  (Again, the Supreme court ruling has left this provision in flux because it allows states to opt out of the Medicaid expansion.)  Since Medicaid coverage is a "bare-bones" type program, it has not traditionally paid for services like music therapy except through state agencies that receive block grants of Medicaid money to use as they see fit.  So the increase in people getting healthcare through Medicaid will probably not directly increase access to music therapy services except possibly via mental health treatment that involves a music therapist in a facility.

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