The ACA and Music Therapy: Revisited!

 

Prezi presentation at the 2015 National Conference of the American Music Therapy Association in Kansas City. 

Handout-ACA an Update

Deciphering the Affordable Healthcare Act One Year Later: Implications for Music Therapy

This Prezi was presented as part of a concurrent session at the 2014 National Conference of the American Music Therapy Association in Louisville, KY.  I invite you to ask questions and make comments regarding the presentation or the effect of Obamacare on music therapy services.

Deciphering the Affordable Care Act One Year Later (1)

Music Therapy Advocacy All Year Round!

Although I officially missed music therapy advocacy month, perhaps I can tie the bow around the effort here on February 1st! 

Kudos to Kimberly Sena Moore for keeping this tradition going every year! This is a great way to remind ourselves of how we must continue the efforts to promote and educate regarding music therapy. I don't think a day goes by that I haven't had the opportunity to explain music therapy to someone! 

Do you have your "elevator" definition of music therapy ready to go?? What about neat stories to tell when you get the chance to talk to someone for a bit longer on a plane or a waiting room? And have you written or called your state and national political representatives recently to remind them about music therapy? 

Here is a message from Dr. Dena Register regarding the theme for music therapy advocacy month in 2014: "We are..." 

Welcome to 2014: Declaring Our Independence 

Dena Register, PhD, MT-BC
Regulatory Affairs Advisor, Certification Board for Music Therapists

The end of the year always brings with it a great deal of reflection. It feels good to look at the accomplishments of the year at its close, set new intentions and imagine new heights for the year ahead. My own professional reflections for this year brought the realization that over the last eighteen years I have enjoyed a rather diverse career in music therapy with roles as a clinician, educator, consultant and professional advocate. One of the most interesting components of wearing so many different “hats” is trying to imagine how those you are working with perceive music therapy.

There is a constant effort to try and imagine how I can best help others understand what music therapy is and the many benefits for our clients. I feel the need to have an analogy for every situation, description, and population. I can’t imagine that I’m alone in this challenge. I know many music therapists that adapt in this chameleon-like fashion when it comes to how we describe our life’s work. We build rapport with our various audiences by searching for some common ground or understanding to use as a point of departure in hopes that they will have that magical “A-ha!” about the many benefits of music therapy. While these experiences help us develop remarkable skills in story sharing and empathy, we are constantly altering the description of our professional identity in order to help others understand us. This task is a complex one for professionals and is one of the challenges that both students and new professionals find difficult to navigate early on in their careers.

I get to teach a class in philosophy and theory of music therapy. Over the last several offerings of this course the students and I have spent hours exploring what music therapy has in common with other therapeutic and creative arts professions. Each semester produces fascinating discussions, diagrams and reflections on the shared aspects of our professions and, more importantly, how music therapy is notably distinct from any other profession or practice. Successful participation in our profession is reliant upon years of skilled musicianship, and a balance of both scientific and artistic knowledge and understanding. It is highly unlikely that an individual who does not have any prior musical training can make their way through varied and rigorous coursework of a music therapy degree and successfully complete the academic, clinical and musical requirements needed.

In the sixty-plus year development of our profession we have learned to be both flexible and savvy in our descriptions of music therapy. These well-honed skills have built a foundation for our profession to grow and expand in ways we didn’t think possible. And, in most recent years, our advocacy efforts have brought us to a place of greater acknowledgement and public awareness than we have ever experienced before. What comes next? It is the era of INDEPENDENCE.

With an increased focus on research about the numerous impacts of music as a therapeutic medium, greater access to quality services by licensed professionals and continuously growing clinical offerings music therapy is positioned for continued, exponential growth. Now is the time for continued clarification to others regarding who we are as a profession as well as our unique qualifications. In 2014, it is imperative that we declare “I am a music therapist” and understand how to articulate our unique qualifications and distinctions from our other therapeutic partners. How will YOU celebrate your ‘independence’ this year?

About the Author: Dr. Dena Register is the Regulatory Affairs Advisor for the Certification Board for Music Therapists and an Associate Professor of Music Therapy at the University of Kansas. She can be reached at dregister@cbmt.org.

Robin Spielberg: Celebrity Spokesartist for the American Music Therapy Association

Robin Spielberg performed at the opening session of the AMTA national conference in Jacksonville, FL this year. She has been a spokesperson for music therapy since 2000.  She was a wonderful performer and wove her stories in between the playing of some of her favorite original piano compositions.  Her new book is:


My wife and I particularly love this album:

Thank you, Robin, for all you do for music therapy!!

21st Century Tools for Educators and Supervisors: There's an App for That!

Here is the handout for our presentation at the 2013 AMTA national conference!  This outline will basically serve as a place to take notes and follow along.  Since we will be demonstrating most of the websites and apps live, there will not be a powerpoint or prezi with the details.  You will just have to attend to find out the details! 

AMTA2013Handout

Deciphering the Affordable Care Act: Its Effect on Music Therapy

• Here is the Prezi from our presentation at the 2013 American Music Therapy Association national conference in Jacksonville! This is just an outline, so please let me know if you have questions. 

• You can also join in the conversation at our Obamacare and Music Therapy Discussion Forum by clicking here or by clicking on the tab at the top of the page. Let's keep the discussion going! It is very important for music therapists to get and stay informed regarding the Affordable Care Act!

References: Deciphering the ACA

Statements Related to Survey

The Affordable Care Act: Effect on Women and Children and Access to Music Therapy

This is a copy of the powerpoint slide presentation from my part of the Institute session November 20, 2013 at the American Music Therapy Association National Conference: Medical Music Therapy for Infants and Children. After a brief review of the timeline, my focus was on parts of the new law that may impact women's and children's access to insurance or medical care, and in effect, their possible access to music therapy. Since this is just an outline, please let me know if you have any questions!

21st Century Teaching Tools for Educators and Supervisors

Here is the handout from our presentation at MARAMTA 2013

Teaching Tools for the 21st Century

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.

Obamacare: The Effect of the Affordable Care Act on Music Therapy, Part I

This is a huge and scary beast to tackle!  Now that the election is over, however, the ACA (Affordable Care Act) looks like it will begin its inexorable creep into the healthcare system.  I present it like this only because the law is scheduled to be implemented in stages.  The first of these new policies began in 2010. The rest of the new regulations will begin over the next few years.  

I will not necessarily be presenting my point of view, although my bias leans against the government being able to do much of anything with efficiency and receive an A grade (I can think of the U. S. Post Office and Amtrak as good examples of government inefficiency which are in constant need of bailout money!).  My goal is to try and give you a sense of the key points of the law and then break it down into some possible influences on how the changes will affect patients with disabilities as well as their access to services like music therapy.  

I also see the bigger picture as something important to examine.  It seems like most people discuss or highlight the benefits or negatives of the new law, but fail to note that actual implementation will not look like the ideal presented on paper.  This is something we can no longer ignore, or put on the mental backburner for another day.  Unfortunately, the ACA is incredibly complicated and many members of congress who voted it into place haven't even read the full document or claim to not understand it!  

At the 2010 Legislative Conference for the National Association for Counties, then House Speaker, Nancy Pelosi said, "But we have to pass the bill so that you can find out what is in it...".   

I have nominated myself to bring you as much detail as a primer for your own investigation!  I will attempt to cite a variety of sources from both sides of the ideological aisle.  I hope that you will join me in the discussion and provide a sounding board as we try to figure this out together.

The music therapy profession is really in its infancy in terms of reimbursement and payment from third-party sources.  Some local and regional success stories exist regarding payment for music therapy services through private insurance companies.  There has also been some progress in getting music therapy included in group billing to Medicare for music therapy occurring as part of daily services in certain types of rehabilitation and care for older adults.  
How will this recent success in third-party billing be affected by the ACA?  Good question!  I am not sure anyone knows exactly, but shouldn't we get at the front end of this?  

Across my virtual desk...

Hi everyone!  

So many things going on right now, it is difficult to quantify!  I don't want you to miss several things that are very current.  I will also write more later about the music therapy conference going on in Chicago at the end of this week, so check back soon!

• If you happen to be one of the lucky ones making it to national conference this year, let's all wish ourselves luck with the transportation to and from the airport to the conference hotel!! :) 
• Once I make it to the conference, you will be able to find me at the exhibit hall with the Shenandoah University booth, or at the research poster session, or at my concurrent session presentation on Friday from 7:30 - 9:00 am.  Early!
• Last year, Ben Folds made a big splash at the conference through twitter and by showing up in person!  This year he is out with a new album.  Some of the profits will go to support music education and music therapy!!  

• You may remember that this year we are doing a sound scape during opening session!  Did you also remember to go and download the sound clips?  Go here and be ready for Christine Stevens, music therapist extraordinaire, and the live experience!
• Just in time for our national conference, TED talks released a wonderful talk by Robert Gupta regarding music and medicine. I have mentioned Mr. Gupta before, a wonderful violinist and advocate for music therapy!  

• I also wanted to highlight some great music therapy being done by a friend of mine, Laura Cornelius.  Here is the write-up at the Florida Sun Sentinel.  Hurray Laura!  

Things are really moving fast out there in the world of music therapy!  Get your twitter feeds ready to go!  I haven't even mentioned the big meetings going on this year about moving music therapy to a master's level entry!  I will write more about that later...

I will catch up with you in Chicago!  Music just makes sense!

Rock-a-bye Horsey...

There was an interesting new study presented at the Australasian Equine Symposium about horses being weaned while listening to sedative music.  Yes, I said horses!  I was impressed by the researchers out of The University of Queensland who tried to define and use sedative music in the study.  While I am not sure that I agree that it was truly sedative or calming in nature, they found some positive results from a cross-over, quasi-experimental design. 

Twelve weanlings were stabled for 10 days with and without exposure to calming music (Alan Silvestri's main theme music to the movie Forest Gump).  The horses had significantly lower heart rate variability during the music condition and were observed to be more relaxed, spent more time eating and less time walking in the stable.  Also of note, the weanlings had a lower peak heart rate and a decreased duration of peak heart rate while in the music condition when they were exposed to the stress of being near two stallions.  

Many questions can be raised about this study, but I found it fascinating nonetheless.  I am not sure exactly which portions of the movie theme music they used, but when I listened to the opening theme to Forest Gump, it was not as predictable and constant in tempo, dynamics, instrumentation, theme and rhythm as would be best for true sedative music.  I also think the horses must not be very selective about their music preference if they can listen to the same 8-10 minutes music selection over and over for 6 hours every day for five days! Perhaps they were less stressed because they were bored silly!  

I don't know how loud they played the music, but it is possible that the music served as a masking agent for environmental sounds.  Was the music the key to the weanling's positive responses?  There is evidence that heart rate variability responds to music intervention as reported by the emWave biofeedback monitor and the creators of the Heart Math program. Can we make any transfers from this research to an effect of music on humans?  Does this study point to a more physiological, nuero-muscular and autonomic response to music rather than a cognitive response?  

I still have more questions than answers, but please take a look for yourself at the details and let me know what you think!

Wilson, M. E., Phillips, C. J., Lisle, A. T., Anderson, S. T., Bryden, W. L., & Cawdell-Smith, A. J. (2012).  Stress responses in young, stabled horses can be modified by music.  Proceedings of Australian Equine Science Symposium, 4, 45.

Playing Catch Up!

Things are off to a sprinter's start here in Virginia!

The national conference for the American Music Therapy Association is happening much earlier this year in the middle of October!  That moves up all the timelines for final preparations for presentations and travel arrangements.  This year, the conference is in St. Charles, IL, at the Pheasant Run Resort.  I will be presenting a concurrent session on Friday, October, 12 from 7:30 - 9:00am:  Arts Ensemble: A Palette for Success in Combined Music and Art Therapy. I hope you will join me if you are coming to Chicago!

Here are a couple of other things that have come across my virtual table the last few months:

• Terra Rising Records contacted me in hopes of broadening their network and getting the word out about their efforts to promote music in education and therapy.  They seem like a commendable group and support many different projects for creating music and raising money to fund music and healing.  You can follow them on Facebook. 
• Jennifer Buchanan also reached out to me to announce her new book about music and wellness.  Her group of music therapists, The JB Music Therapy Team, includes a highly qualified list of credentialed music therapists.  You can find out more about her new book here.   

Stay tuned for more links and news as I try to get back into the groove!  Thanks for sticking with me over the summer!      

On The Banks of the Shenandoah...

I'm Back!

Sorry for the long hiatus, but I finally managed to get my family moved to Virginia for the start of a grand new adventure!  This involved packing up a 27 foot trailer and sending it off into the unknown with only a tracking number in hand.  After a couple of months in Texas visiting family, we headed out for Virginia.  So the big news is...

I have officially started as a new music therapy professor at Shenandoah University!  I am very honored to be here with such a vibrant and well-respected music therapy program and I look forward to many great things to come!...(Now if I can only figure out how to use my new Macbook, things will be splendid!...)

The first order of business is that things will be changing here at Music Makes Sense.  The "Daily Muse" feature will be put on the back burner while I settle in here for my new gig.  That will leave room for 1-2 quality posts a week and time to correspond with all of you via comments, twitter and the Facebook page.  I hope you will continue to spend some time here each week and join in the conversation.

There should be much to talk about as I explore music therapy in this new part of the country!  And stay tuned for more information about the upcoming AMTA national conference!  I will be presenting a concurrent session as well as participating in the research poster session.  So don't miss out!  If you haven't already, subscribe to MMS by email or Like it on Facebook.  I hope everyone had  great summer and that you feel refreshed for the fall!

Let's go!

State License for Music Therapy in Georgia

The governor of Georgia finally signed into law the SB 414 providing a state license for music therapists!  


Here are the details form Kimberly Sena Moore (with the Certification Board for Music Therapists):




The American Music Therapy Association (AMTA) and the Certification Board for Music Therapists (CBMT) are excited to announce that, on Tuesday, May 1, 2012, Governor Nathan Deal of Georgia signed into law SB 414. This legislation creates a music therapy license in Georgia through the Secretary of State. Many thanks to the members of the Georgia Task Force (Rachel Coon-Arnott, Jamie George, Kirby Smith, Chelsey Mercado, Pat Coates, and Ellen Ritchey) and to all the music therapists in Georgia for their work, dedication, and advocacy for this legislation.


Great job!

GA Music Therapy Licensure Bill Still Awaits Signature

The Governor of Georgia, Nathan Deal, still has not signed the bill into law regarding state licensure for music therapy.  Here are the details as provided by Nelson Mullins:


SB 414 was authored by Sen. Renee Unterman (R-Buford) and deals with licensing individuals who are engaging in the practice of music therapy.  There are currently about 125 individuals in Georgia who are "music therapists."  The legislation creates this new licensure under the Secretary of State in Chapter 25A of Title 43.  


The Bill, as it passed the House, is the negotiated agreement worked out by the various groups who had raised concerns (including speech-language pathologists, occupational therapists, psychologists and others) about the Bill because it lacked a true scope of practice for these folks.  It is still viewed as an unfunded mandate to the Secretary of State which has the responsibility of licensing this new group.  It passed the House by a vote of 116 to 49.  The Senate, upon a motion made by Sen. Unterman, agreed to the House version of SB 414 by a vote of 45 to five and that action now moves the legislation to the Governor's desk.


Governor Deal has 40 days in which to take action on Bills passed this Session; that time expires on May 8, 2012.  The Governor's office keeps an updated webpage for signed bills here.

More Cool SER-AMTA Stuff!

Natalie Mullis is a music therapist in private practice and author of the blog: Key Changes Music Therapy.  She is definitely a rising star in the music therapy field and has jumped into the profession with lots of excitement!  


I was not able to attend her conference presentation at the Southeastern Regional American Music Therapy Conference 2012 this past weekend, but several of my students and colleagues were able to listen to her speak.  I heard many good comments about the information she shared, so if you would like a copy of her presentation handout, Natalie has posted one on her blog.  Check it out here, and don't miss the opportunity to get her e-book about being successful as a young professional!  

Music Therapy is Not Just a "Frill Service"

According to the Health Sciences Association of British Columbia, a large public union in Canada, there are over 40 music therapists listed as being members of their organization.  Unfortunately, healthcare downsizing is often resulting in the loss of music therapy jobs held by these union members.  


Although there are some expansions of music therapy into the hospitals and healthcare taking place in the U. S., there is still the idea out there that music therapy can be cut since it is not an "essential service."


In response to this lack of understanding regarding music therapy, the Music Therapy Association of British Columbia has released a video called, "The Gift of Music: Stories of Music Therapy."  The creators talk about the documentary: 

GA State Bill for Music Therapy Licensure Passes Both House and Senate!

Congratulations Georgia MTs!


The Georgia state bill to establish a music therapy license passed the Georgia State House of Representatives yesterday.  It has now passed both the House and the Senate and I assume awaits signing by the Governor.  Hopefully, he does not have a problem with this idea!  

With a Little Help From The Beatles!

If you ever need a little dose of the Beatles, here is a nice little webpage that can get you through the moment!  It is a fun little, old-school, online tape player packed with Beatles tunes!


Beatles songs are great for music therapy.  I use them all the time for teenagers and young adults who have developmental disabilities.  The songs are easy to play and have catchy tunes that are often somewhat familiar just because they have been used in so many different types of media.  


I also just used the song, "With a Little Help From My Friends" (...with a slight word edit in the chorus since I was working with psychiatric patients who might have dual-diagnosis...!), to talk about being helpful and friendly with other patients and their treatment team.  


Go to the Beatles player here!