10/14/2017

1

Session 70: OT Issues Around the Country: The National Perspective and the View from Sacramento

October 21, 2017

1

Sabrena McCarley, MBA‐SL, OTR/L, CLIPP, RAC‐CT

2

Chair Advocacy and Government Affairs 

Committeegachr@otaconline.org

Chuck Willmarth, CAE

3

AOTA Director of Health Policy 

and State Affairs

10/14/2017

2

Ivan Altamura, JD

4

Capitol Advocacy OTAC Lobbyist

Jennifer Snyder, MPH

5

Partner at Capitol Advocacy 

OTAC Lobbyist

Health Care Reform

Chuck Willmarth, CAEAssociate Chief Officer, Health Policy and State Affairs

OT Issues Around the Country 

and the View from SacramentoOTAC Annual Conference

Saturday, October 21

2:30 – 4:00pm

10/14/2017

3

ACA Principles

• Near‐universal coverage through Medicaid expansion and new, subsidized health insurance marketplaces 

• Encouraging state‐level innovation (e.g. state‐based marketplaces, State Innovation Waivers)

• Bending the cost curve through payment and delivery system innovations

How did the ACA change the individual and small group markets?

• Prohibited insurance companies from rejecting applicants, or charging them more, because of pre‐existing conditions

• Guaranteed a set of 10 essential health benefits (EHBs)

• Banned annual and lifetime dollar limits on EHBs

• Capped annual out of pocket costs (co‐payments, co‐insurance, deductibles) for the EHBs

• Required plans to adhere to fixed levels of coverage that guarantee the percentage of total costs that will be paid by the plan rather than the policy holder (metal levels)

Types of ACA Marketplaces

10/14/2017

4

How did the ACA affect the uninsured rate?

• Last year the uninsured rate hit an all‐time low:

– In 2016, 8.8% (28.1 million) were uninsured

– That’s 20.5 million fewer than when the ACA was enacted

What to expect for open enrollment?

• Average premium increases: 20%

– Wide variation across/within states

• Fewer choices as insurers exit the individual market

– In danger of “bare counties”

• Instability largely due to cost‐sharing reduction (CSR) payment uncertainty and individual mandate enforcement

What are “essential health benefits?”

Source of image: http://modernmedicines.com/small_essential_health_benefits.png

Complete list of EHBs in the Affordable Care Act1. Ambulatory patient services2. Emergency services3. Hospitalization4. Maternity and newborn care5. Mental health and substance use disorder services, including behavioral health treatment6. Prescription drugs7. Rehabilitative and habilitative services and devices8. Laboratory services9. Preventive and wellness services and chronic disease management10. Pediatric services, including oral and vision care 

10/14/2017

5

What’s the difference between habilitation and rehabilitation?

A uniform definition of habilitative services

OT in the SBC

10/14/2017

6

Medicaid Expansion Map

What’s the state of Medicaid expansion?

• Thanks to the Supreme Court, states got a choice

• This year states get a 95% federal match for the expansion population– Will phase down to 90% in 2020 and thereafter

• Among the 31 states (and DC) that have expanded:– Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, and New Hampshire have used Section 1115 demonstration waivers

Administrative actions can repair the ACA – or destroy it

• President’s executive order on day one: “waive, defer, grant exemptions from [and] delay implementation of” burdensome ACA regulations– IRS actions to relax enforcement of individual mandate

• HHS/CMS calling on governors to seek waivers to ACA Marketplace and Medicaid rules

• The administration has not promised to keep paying the CSRs this year; now month‐to‐month

• Congress has not promised to appropriate money for CSRs in the future

10/14/2017

7

What are 1332 waivers?

• The ACA created 1332 waivers to allow states to develop alternative approaches to meeting the coverage goals of the ACA– Hawaii (December 2016) and Alaska (July 2017)

• HHS has encouraged ideas like high risk pools, reinsurance, and other innovations to stabilize the risk pools

• States could waive EHBs and other central elements of the ACA

What are 1115 waivers?

• Demonstration waivers that have been around longer than Medicaid itself

• 1115 waivers have been used to do “experimental” Medicaid expansions– The new head of CMS helped design Indiana’s first‐of‐its‐kind waiver

• HHS Sec and CMS Admin letter to governors suggested CMS would approve work requirements

• Want to apply concepts from expansion waivers to the entire program

“Repeal and Replace” Timeline

• 1st day of new Congress: 2017 budget resolution with reconciliation instructions

• American Health Care Act (AHCA)

– Passed the House May 4, 2017

• Better Care Reconciliation Act (BCRA) 

– Failed to pass the Senate July 27, 2017

• Graham‐Cassidy introduced mid‐September

• Sept 30: 2017 budget resolution expires

10/14/2017

8

Market Stabilization

• Series of Senate HELP Committee hearing, September 2017 seeking bipartisan fixes, discussed:– Years‐long appropriation for CSR payments

– Federal reinsurance program 

– Making 1332 waivers easier to get

– Funding outreach & enrollment assistance

– Making catastrophic plans widely available

• Talks broke down after Graham‐Cassidy intro

Graham‐Cassidy‐Heller‐Johnson

• Caps Medicaid • Replaces ACA marketplaces and Medicaid expansion with a temporary block grant

Graham‐Cassidy and Medicaid

• The ACA expanded Medicaid eligibility to all individuals up to 138% of poverty

• Graham‐Cassidy would fundamentally restructure all of Medicaid by changing it from an open‐ended entitlement to a capped program

– Per capita cap 

– Block grant

• Allows states to impose work requirements

10/14/2017

9

What is a per capita cap?

• The federal government would contribute a set amount per beneficiary starting in 2020

• Separate caps or allotments for five categories of beneficiaries:

– Elderly

– Disabled

– Children

– Adults

• Capped amounts would grow more slowly than under current law

What is a block grant?

• States would have the option of selecting a block grant instead of a per capita cap for a portion of their federal Medicaid funding

• Block grants permitted for non‐elderly, non‐disabled adults

• Free from most federal requirements, including:– EPSDT

– Statewideness

– Amount, duration, and scope

– Free choice of provider

Graham‐Cassidy and Obamacare 

• A truer “repeal” than the House and previous Senate health care bills

• Repeals individual/employer mandates

• Repeals Medicaid expansion

• Repeals ACA marketplaces and federal subsidies for low‐income enrollees

– Tax credits & CSRs

10/14/2017

10

Graham‐Cassidy’s Block Grants

• Replaces Medicaid expansion and subsidized marketplaces with block grant 

• Block grant redistributes federal funds among the states– Away from states getting more federal $ now because of Medicaid expansion and/or high marketplace enrollment

• Around $1.2 trillion over 7 years (2020‐2026)– 2027 and beyond = ?

Medicaid Funding

Source:

http://avalere.com/expertise/managed‐care/insights/graham‐cassidy‐heller‐johnson‐bill‐would‐reduce‐medicaid‐funds‐to‐states‐by

Potential Impact

• Will insurance and Medicaid cover OT?

• What will happen to hospitals? Do you work in an acute or rehabilitation hospital?

• Will children be affected? Do you work in schools?

• Are you concerned about discrimination?

• What will happen to the insurance market? What will happen to your own health insurance?

10/14/2017

11

AOTA Resources

AOTA Legislative Action Center

HCR Blog on OT Connections

What’s next?

• Executive Order – Association Health Plans

• State Waivers

• HHS/CMS regulations and/or guidance

• Compromise to stabilize marketplaces

• Another proposal to repeal and replace using next year’s budget reconciliation process

OTAC Advocacy and 

Government Affairs Committee

Presented by: Sabrena McCarley, MBA‐SL, OTR/L, CLIPP, RAC‐CT 

33

10/14/2017

12

Home Health Groupings Model (HHGM)

• New HH payment model published in HH PPS proposed rule 7/28/17; Could be effective 1/1/19 or later

• Would change payment for OT and other HHA services– Removes therapy thresholds; Could cause reduction in use of OT and other therapy

• Why did CMS propose HHGM?– Use of therapy thresholds under scrutiny by Congress, MedPAC

HHGM

• Would remove therapy visits as HH PPS payment determinant

• Relies on the following to place patients into 1 of 144 payment groups:– Clinical characteristics & Diagnosis= 1 of 6 Clinical Groups

– Functional level (low, medium, high)

– Comorbidities

– Admission source (institutional or community)

– Episode timing (early (1st 30 days) or late)

HHGM Concerns

• HHGM does NOT include protections to ensure patients receive medically necessary therapy; Risk rationing of care

• Clinical Groups don’t fully reflect scope of therapy services• Doesn’t prevent use of aides to provide services• Functional payment adjustment doesn’t include cognition, 

IADLs, vision• Only 1 comorbidity adjustment no matter # of 

comorbidities• Adds administrative burden w/ use of 30‐day payment 

periods• No pilot testing

10/14/2017

13

Resource Classification System‐I (RCS‐I)

• May 2017 Advanced Notice of Proposed Rulemaking (ANPRM)‐ NO proposed rule yet

• Follows MedPAC and Congressional scrutiny

• Several CMS/Acumen TEP meetings held beginning in early 2015‐ late 2016

– AOTA represented at table by Dr. Natalie Leland, PhD, OTR/L, BCG, FAOTA

• RCS‐I would replace existing RUG‐IV SNF PPS

RCS‐I

• Goal: Move away from RUG system of counting minutes to system based on patient characteristics

• Incudes 4 case‐mix adjusted components:

– OT/PT (Bundled together)*

– SLP 

– Nursing and Social services 

– Non‐therapy ancillary services

RCS‐I: OT and PT Component

• CMS states OT and PT services component combined because data shows very little difference between OT and PT patient characteristics

• OT/PT payment further refined by 3 MDS patient factors:– Clinical Reason for SNF Stay

– Functional Status

– Cognitive Status

10/14/2017

14

RCS‐I: Clinical Reason for SNF Stay

• Major Joint Replacement or Spinal Surgery

• Other Orthopedic: orthopedic surgery (except major joint) and non‐surgical orthopedic/musculoskeletal

• Non‐Orthopedic Surgery

• Acute Neurologic

• Medical Management: acute infections, cancer, pulmonary, cardiovascular and coagulations, medical management

RCS‐1

• AOTA’s concerns are significant and many

• OT/PT bundle for payment could incentivize provision of PT but not OT

• Clinical categories too broad

• Co‐morbidities not considered

• Use only initial, discharge and “significant change” assessment. All other assessment periods eliminated.

Are Medicare Episodic Payment Models (EPMs) Being Phased Out?

• August 2017 NPRM would cancel 3 EPMs (AMI, CABG, SHFFT), Cardiac Rehab incentive payment model , and revises Comprehensive Care for Joint Replacement (CJR)

• Proposes CJR be voluntary rather than mandatory for all hospitals in approximately 33 of the participating 67 Metropolitan Statistical Areas (MSAs) 

• “While these models offer opportunities to redesign care processes and improve quality and care coordination across the inpatient and PAC spectrum... it is not in the best interest of the agency to move forward with these models”

10/14/2017

15

MACRA

• MACRA is the Medicare Access and CHIP Reauthorization Act. MACRA replaces the current Medicare reimbursement schedule with a new pay‐for‐performance program that’s focused on quality, value, and accountability. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service.

• President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA) on April 16, 2015. It passed with a 392 to 37 vote in the House of Representatives, and a 92 to 8 vote in the Senate. That bipartisanship indicates the legislative support for MACRA and the significance of the bill in U.S. healthcare reform.

MACRA

• CMS has contracted with Acumen, LLC to develop new episode‐based cost measures for use in the Quality Payment Program

• Acumen has recruited 145 clinicians affiliated with 96 specialty societies to participate in the Clinical Subcommittees

• These Clinical Subcommittees are essential for acquiring vital clinical input needed for the development of cost measures

MACRA

• The episode‐based cost measures, which will be reported during field testing to group practices and solo practitioners who meet a 10‐episode case minimum for at least one measure during the measurement period of 06/01/16 to 05/31/17, are the following:– Elective Outpatient Percutaneous Coronary Intervention (PCI) – Knee Arthroplasty – Revascularization for Lower Extremity Chronic Critical Limb Ischemia– Routine Cataract Removal with Intraocular Lens (IOL) Implantation– Screening/Surveillance Colonoscopy – Intracranial Hemorrhage or Cerebral Infarction – Simple Pneumonia with Hospitalization – ST‐Elevation Myocardial Infarction (STEMI) with PCI 

10/14/2017

16

OT Issues Around the Country: the View from Sacramento

Jennifer Snyder & Ivan Altamura Capitol Advocacy

Federal Laws impacting California

• Health care reform

• Health exchanges

• Essential health benefits

• Federal subsidies

• Medicaid block grants ‐ per capita limits

• Medicaid expansion – freeze in 2020

Estimated loss to California in federal funds

10/14/2017

17

California Residents Support the ACA

• More than half (56%) of Californians surveyed are worried that they or someone in their family will lose coverage if the ACA is repealed and replaced.

• Support for the ACA is now at a record high, with supporters outnumbering opponents by greater than a two‐to‐one margin (65% to 26%), with 45% supporting it strongly.

• 88% of Californians say Medi‐Cal is important to the state (72% say very important, 16% say somewhat important). Importance of the program shared widely across the state's regions and political parties; 75% of California Republicans deem the program important.

• More than two in three (69%) Californians say Medi‐Cal is important to them and to their families. 

California residents support mental health & substance abuse coverage

• Three in four Californians surveyed (74%) believe this coverage is very important.

• Two in three say they would be very likely to seek professional help for a mental health condition (66%) or for an alcohol or drug use problem (65%).

• Three in four say they believe that treatment for mental health conditions (75%) and alcohol or drug use problems (77%) can help people lead healthy and productive lives.

California’s Response

• Covered CA to remain fully functional

• Continue essential health benefits

• Intent on continuing full coverage of Medi‐Cal

• Impact on providers

• Impact on CA state budget

10/14/2017

18

Covered California• Covered CA provides health insurance for over 1.5 

million people• Uninsured rate reduced from 16% in 2013 to 7% in 

2016.• One in three of California's uninsured had annual 

incomes of less than $25,000. At this income level, people are potentially eligible for Medi‐Cal.

• Of the state's remaining uninsured, one in four were age 25 to 34, one in three were noncitizens, and more than half were Latino.

• 62% of the uninsured were employed. Of the 1.8 million uninsured workers, 44% worked in firms with fewer than 50 employees.

• Fewer Californians cited "lack of affordability" as the main reason for going without health insurance in 2015 compared to 2014.

California Single Payer Health Care

• CA Legislature considering a single payer health care system 

• SB 562 passed Senate• Speaker Rendon held bill in Assembly 

Rules• Select Committee on Health Care 

Delivery Systems and Universal Coverage to hold hearings

• Hearings will review:– Who is and is not currently covered – Current coverage systems, including public programs, safety 

net providers and employer‐based and individual market coverage 

– How current systems are financed – Versions of universal health coverage around the globe

What Does Health Care Reform Uncertainty Mean for California? 

• More questions than answers at Federal level

• President Trump not giving up on “Repeal and Replace”

• Uncertainty regarding loss of federal funding

• Governor and Legislative Leaders are committed to protecting the healthcare safety net for Californians

• More progressive steps forward in health care

• How to pay for expanded healthcare coverage

– Desire  vs.  Costs

10/14/2017

19

55

Acronym Definition

AB Assembly Bill

ACA Affordable Care Act

ACO Accountable Care Organization

ADA Americans with Disabilities Act

ADV Advocate

AGAC Advocacy and Government Affairs

AMA American Medical Association

AOTA American Occupational Therapy Association

APM Advanced Alternative Payment Models

B & P Committee on Businness and Professions

CBOT California Board of Occupational Therapy

CCIIO Center for Consumer Information and Insurance Oversight

CMS Centers for Medicare and Medicaid Services

CoveredCA California's Health Care Exchange

CPT Current Procedural Terminology

DHCS Department of Health Care Services

FFS Fee For Service

FSA Flexible Spending Account

HCPCS Healthcare Common Procedure Coding System

HH Home Health  

HHGM Home Health Groupings Model 

HHS Health and Human Services

HMO Health Maintenance Organization

ICD‐10 International Classification of Diseases, Tenth Revision

ICF International Classification of Functioning, Disability and Health

IRF Inpatient Rehabilitation Facility

LCD Local Coverage Determinations

MAC  Medicare Administrative Contractor

MACRA The Medicare Access and CHIP Reauthorization Act of 2015

MDS Minimum Data Set

MedPAC Medicare Payment Advisory Commission 

MIPS The Merit‐based Incentive Payment System

MMR Manual Medical Review

MUEs Medically Unlikely Edits

NBCOT National Board for Certification in Occupational Therapy

NCCI Edits National Correct Coding Initiative Edits

NPI National Provider Identifier

OTAC Occupational Therapy Association of California

PAC Political Action Committee

PPO Preferred Provider Organization

PPS Prospective Payment System

QPP Quality Payment Program

RAC Recovery Audit Contractor

RCS‐I Resource Classification System‐I 

RUG Resource Utilization Group

SB Senate Bill

SNF Skilled Nursing Facility

TRICARE Managed Healthcare System for military families

OTAC NPS/NPA Audit Fix

OTAC worked diligently in 2017 with the California Department of Education (CDE) on budget trailer bill language (so-named because it would have “trailed” the actual budget bill) to fix a cost-prohibitive nonpublic school (NPS)/nonpublic agency (NPA) certification audit requirement for OTs that provide services to students in school settings. Although the full problem was not resolved this year, OTAC was able to delay implementation until 2019 so that we can work to resolve the issue via legislation next year. Last year (2016), the CDE issued a notification letter to NPS and NPA certification applicants regarding an entity-wide annual audit requirement. An audit report performed by a CPA would have to be included with the certification application, which would cost upwards of $10,000. Although this audit requirement was enacted in 1999, it was never implemented by CDE. Instituting this expensive requirement now will negatively impact OT practitioners and occur at the expense of the state’s special needs students. NPS/NPAs contract with OTs and OTAs, who, as part of the education team in schools, use their unique expertise to help children prepare for and perform important learning and school related activities and to fulfill their role as students. The audit report requirement will be cost prohibitive for many NPS/NPA certification applicants, who will be unable to apply for certification and will be prevented from providing essential services to students in need. To mitigate this problem, OTAC has been working collaboratively with CDE on the development of legislation in 2018 to allow NPS/NPA certification applicants to continue to be part of the education team to address student needs in schools. Specifically, the current proposal removes the audit requirement for NPS/NPA certification applicants who make less than $300,000 from their contracts with schools; would require a statement of revenues with attestation by the applicant for NPS/NPA making between $300,000 to $2 million; and for those NPS/NPA making over $2 million would require a full audit. If passed, this modification will address the financial burden current law places on small providers and allow OT practitioners to continue to help promote healthy school climates that are conducive to learning. The Legislature is in recess until January 3, 2018. OTAC is working with the Assembly Education Committee to identify a two-year bill that can be amended, passed and sent to the Governor before January 31, 2018 to address this issue in time to prevent audit notices being sent out next year. If a two-year bill is not identified, legislation addressing this problem will be introduced by the end of February, and would need to pass out of the Legislature by August 31, 2018.

OT and PT Service Credential

2017 Legislative Update

AB 1087 by Assemblywoman Jacqui Irwin (D-Thousand Oaks) was introduced this year

as a vehicle to allow occupational therapists (OT)s and physical therapists (PT)s to obtain

a Services Credential through the Commission on Teacher Credentialing (CTC). A

credential option would ensure continued and future high quality OT personnel

knowledgeable in educationally related standards to impact the education and future of

California’s students, schools and communities in a variety of positions within the public

school setting.

Current law does not give OTs an option to obtain a credential. Examples of current

credentialed personnel include teachers, school psychologists, school counselors, social

workers, nurses, audiologists, and speech and language pathologists. OTs have been

providing educationally related services to students in public schools for over four

decades. OT services are mandated under the Individuals with Disabilities Education Act

(IDEA, 2004) and designed to help children with complex medical, developmental and

educational needs develop, improve, or restore functional and academic skills, to support

access and progress in their educational environment. OT services can be essential for

students, promoting function and engagement in everyday routines and preparing

children to be college and career ready. There are approximately 16,000 occupational

therapists and occupational therapist assistants currently licensed in California, of which

nearly 20% (3,065) are estimated to practice in school-based settings.

The Credential will provide the necessary reconciliation between the level of education,

preparation, and licensure OTs currently undergo to provide OT services. OTs may hold

a bachelors, masters or doctoral degree (the entry level requirement for doctoral degrees

goes into effect for 2027 graduates). They have proven abilities to augment student

outcomes within the school-based setting while serving as integral and collaborative team

members at all levels.

AB 1087 was not acted upon this year, so it is currently a 2-year bill, eligible to be

considered in January 2018. If not passed, and sent to Governor Brown by January 31,

2018, OTAC will work with the Commission and Assemblywoman Irwin’s office to

introduce and pass a new bill containing similar language next year.

OTAC’S TOP 2017 LEGISLATIVE PRIORITIES AB 1706 – Support Signed by the Governor AB 1706 by the Assembly Business & Professions Committee extends the sunset on CBOT until 2022, thereby continuing its existence and operation. Every four years, all licensing boards under the Department of Consumer Affairs are subject to renewal and must undergo “sunset review,” or legislative oversight. OTAC has been very involved in the sunset review process and supportive of the board’s mission to protect consumers and uphold high standards of practice and competency for OT practitioners. OTAC worked with the Board and the Senate and Assembly Business and Professions Committee staff to ensure that language harmful to OT practitioners was not amended into AB 1706, e.g. fee increases for Advance Practice Continuing Education Unit (CEU) course approvals and/or to recover costs to CBOT for disciplinary actions against practitioners. Just last year, the Board approved license fee increases for OTs and OTAs – additional new fees now would be harmful to OT practitioners in California and jeopardize access to qualified occupational therapists. In addition, many licensees on probation who are unable to work would find it extremely difficult to reimburse the Board for disciplinary costs. AB 1706 passed out of the Legislature and was signed by the Governor on October 3rd. SB 547 – Watch Signed by the Governor SB 547 by Senate Business, Professions and Economic Development chair Jerry Hill (D-San Mateo) is a Senate bill that was amended in the final month of session this year to allow CBOT to charge licensees a query fee for background checks. As part of the AB 1706 negotiations, OTAC worked with CBOT and legislative staff to ensure the query fee included in SB 547 is limited to only the amount charged for the background checks. In addition, OTAC worked diligently to ensure that several other fee increases that would have negatively impacted licensees and continuing education providers were not included in SB 547. The bill passed out of the Legislature and was signed by the Governor on October 2nd. AB 1087 – Support 2-Year Bill AB 1087 by Assemblywoman Jacqui Irwin (D-Thousand Oaks) will allow OTs and PTs to obtain a Services Credential through the Commission on Teacher Credentialing (CTC), which will ensure continued and future high quality OTs can impact the education and future of California’s students, schools and communities. Current law does not give OTs an option to obtain a credential. Examples of current credentialed personnel include teachers, school psychologists, school counselors, social workers, nurses, audiologists and speech and language pathologists. OTs have been providing educationally related services to students in public schools for over four decades. OT services are mandated under the

Individuals with Disabilities Education Act (IDEA, 2004) and designed to help children develop, improve, or restore functional and academic skills, to support access and progress in their educational environment. OT services can be essential for students promoting function and engagement in everyday routines preparing children to be college and career ready. There are approximately 16,000 occupational therapists and occupational therapist assistants currently licensed in California, of which nearly 20% (3,065) are estimated to practice in school-based settings. The Credential will provide the necessary reconciliation between the level of education, preparation, and licensure OTs currently undergo to provide OT services. OTs have a proven ability to augment student outcomes within the school-based setting while serving as integral and collaborative team members at all levels. AB 1087 was not acted upon this year, so it is currently a 2-year bill, eligible to be considered in January 2018. If not passed, and sent to Governor Brown by January 31, 2018, OTAC will work with the Commission and Assemblywoman Irwin’s office to introduce and pass a new bill containing similar language next year. AB 387 – Oppose Failed Assemblyman Tony Thurmond (D-Richmond) carried AB 387 this year, which sought to require health facilities to pay allied health professional students minimum wage for clinical or experiential education hours that are required for licensure. The bill was much too broad and would have negatively impacted the OT workforce in California by disincentivizing health facilities and employers from providing fieldwork placements to OT students. Existing ACOTE Accreditation Standards prohibit OT students, who are in training in their respective fields, from providing care without proper supervision from a licensed OT with at least one year’s experience. Supervising an OT student is time-intensive and liability for OT students in training is held by the licensed supervising OT. Mandating that clinics and other health facilities compensate OT students is counterintuitive and would have decreased necessary learning opportunities, thereby exacerbating the healthcare workforce shortage. In light of California's current access to care issues, and the uncertainty with respect to the ACA, policies that foster growth in the healthcare workforce are critical. AB 387 was directly contradictory to this goal. OTAC, along with a larger coalition of stakeholders in opposition, was able to defeat the bill at the House of Origin deadline in June. It never came up for a vote on the Assembly Floor and died for the year. AB 1510 – Oppose Failed AB 1510 by Assemblyman Matt Dababneh (D-Encino) sought to license athletic trainers (ATs) under the California Board of Occupational Therapy (CBOT). OTAC was successful in stopping the bill after Assemblyman Dababneh dropped it for the year. Specifically, AB 1510 would have enacted the Athletic Training Practice Act, creating licensure for ATs under the CBOT. While OTAC has supported AT title protection bills in the past, AB 1510 was much too broad, allowing too much room for interpretation with respect to the rehabilitation and reconditioning practices ATs would have been able to perform. Further, as the number of licensed OT and OTA practitioners continues to increase, CBOT is not the appropriate oversight body for ATs as its focused oversight of OT and the people served by OTs is critically important.