TY - JOUR
T1 - Occupational Therapy Service Delivery Among Medicaid-Enrolled Children and Adults on the Autism Spectrum and With Other Intellectual Disabilities
AU - Benevides, Teal W.
AU - Tao, Sha
AU - Becker, Alec
AU - Verstreate, Kate
AU - Shea, Lindsay
N1 - Publisher Copyright:
© 2022 American Occupational Therapy Association, Inc. All rights reserved.
PY - 2022/1
Y1 - 2022/1
N2 - Importance: Rates of occupational therapy service utilization among people with autism spectrum disorder (ASD) or intellectual disability (ID) have not been explored in population-based samples. Objective: To describe occupational therapy services delivered to Medicaid-eligible persons younger than age 65 yr identified as having ASD, ID, or both and to evaluate demographic factors associated with occupational therapy service utilization in this population. Design: Retrospective, case–control, cohort study using claims records from Medicaid Analytic eXtract files (2009–2012). Setting: Data from all 50 states and Washington, DC. Participants: Beneficiaries identified as having ASD only, ASD1ID, or ID only who were younger than age 18 yr (N 5 664,214) and ages 18–64 yr (N 5 702,338). Outcomes and Measures: We analyzed Current Procedural Terminology® and Healthcare Common Procedure Coding System procedure codes, Medicaid Statistical Information System type of service codes, and Center for Medicare & Medicaid Services provider specialty codes. Results: Only 3.7% to 6.3% of eligible adult beneficiaries received occupational therapy; in contrast, 20.5% to 24.2% of children received occupational therapy. Significant predictors of service use varied by group; however, differences by race–ethnicity, eligibility on the basis of poverty, and geographic location were observed. Among children, the most frequent billing code was for “therapeutic activities” (43%–60%); among adults, it was “community/work reintegration training” (29%–39%). Conclusions and Relevance: Billed procedure code patterns do not consistently reflect the unique occupational focus that occupational therapy providers deliver to people with developmental disabilities. Disparities in occupational therapy receipt warrant further attention to understand the social and structural factors affecting service delivery.
AB - Importance: Rates of occupational therapy service utilization among people with autism spectrum disorder (ASD) or intellectual disability (ID) have not been explored in population-based samples. Objective: To describe occupational therapy services delivered to Medicaid-eligible persons younger than age 65 yr identified as having ASD, ID, or both and to evaluate demographic factors associated with occupational therapy service utilization in this population. Design: Retrospective, case–control, cohort study using claims records from Medicaid Analytic eXtract files (2009–2012). Setting: Data from all 50 states and Washington, DC. Participants: Beneficiaries identified as having ASD only, ASD1ID, or ID only who were younger than age 18 yr (N 5 664,214) and ages 18–64 yr (N 5 702,338). Outcomes and Measures: We analyzed Current Procedural Terminology® and Healthcare Common Procedure Coding System procedure codes, Medicaid Statistical Information System type of service codes, and Center for Medicare & Medicaid Services provider specialty codes. Results: Only 3.7% to 6.3% of eligible adult beneficiaries received occupational therapy; in contrast, 20.5% to 24.2% of children received occupational therapy. Significant predictors of service use varied by group; however, differences by race–ethnicity, eligibility on the basis of poverty, and geographic location were observed. Among children, the most frequent billing code was for “therapeutic activities” (43%–60%); among adults, it was “community/work reintegration training” (29%–39%). Conclusions and Relevance: Billed procedure code patterns do not consistently reflect the unique occupational focus that occupational therapy providers deliver to people with developmental disabilities. Disparities in occupational therapy receipt warrant further attention to understand the social and structural factors affecting service delivery.
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U2 - 10.5014/ajot.2022.049202
DO - 10.5014/ajot.2022.049202
M3 - Article
C2 - 35030249
AN - SCOPUS:85123568139
SN - 0272-9490
VL - 76
JO - American Journal of Occupational Therapy
JF - American Journal of Occupational Therapy
IS - 1
M1 - 7601180100
ER -