Advocacy Resources

TNOTA believes that advocacy is critical to maintaining the health and visibility of occupational therapy in Tennessee. Membership in TNOTA supports our efforts to represent occupational therapy in legislative and regulatory affairs and gives a powerful, united voice to occupational therapy practitioners across our state. TNOTA is always working to develop more publicly available resources to enable OT practitioners, educators, and students to better advocate for our profession. If you have a resource you'd like to see, contact [email protected].

Resource Alert:

Check out our new Tennessee Telehealth Practice ExplainerRoadmap to Making Changes to the OT Practice Act, and the OT Advocacy Toolkit!


Advocacy Victory! May 2023

Posted May 17, 2023

TNOTA is grateful to our lobbyist partners at Capitol & 5th Public Strategies for diligently tracking bills impacting the occupational therapy profession. Check out their summary of the legislation we tracked on a state level in 2023. Of note- TNOTA worked with our friends at the Tennessee Association of Audiologists and Speech Language Pathologists (TAASLP) to pass a bill requiring our respective licensure boards to review and make a determination on licensure applications within 60 days of receiving a completed application. This will expedite the licensure application process and hold the licensure boards to a higher standard of accountability. 


Advocacy Victory! February 2023

TNOTA has been closely monitoring OTA supervision guidelines issued by Blue Cross Blue Shield of Tennessee in previous versions of their payer manual. In short, BCBS and their affiliates had required an overly stringent level of supervision for OT Assistants, comparable to the supervision requirements for a rehab technician, which resulted in reimbursement issues for OTA-rendered services. Working with our lobbyists, TNOTA was able to advocate for the supervision guidelines for OTAs billing to BCBS to be relaxed, and conform to industry standards. This is reflected in their most recent payer manual. Special thanks to all who helped us advocate for this important change!


Advocacy Update: February 12, 2023

TNOTA continues to work closely with our lobbyists to monitor legislation that may impact OT practice in our state. Additionally, TNOTA ensures that a member of our executive board is in attendance at each meeting of the Tennessee Board of Occupational Therapy, in order to understand and share  relevant information. Updates from the February 9, 2023 board meeting can be found below. The public may also review licensure board meeting minutes, posted on the state's website.

  • Along with representatives from TNOTA's Practice Act Revisions task force, the licensure board will meet virtually on February 23, 2023 to review proposed revisions to the OT Practice Act in Tennessee. TNOTA will provide additional updates as they become available.
  • The licensure board recently voted to increase renewal fees; exact pricing and date of implementation are TBD
  • The licensure board confirmed that it will honor continuing education credits earned during the "gap period" resulting from the change in license renewal date requirements. The board will include this on their website in their list of Frequently Asked Questions.
  • Rules pertaining to the Practice of Dry Needling will go into effect as of March 19, 2023. This means that OTs with proper training will be able to practice Dry Needling, once certified, after that date. The board will work to develop an application for Dry Needling certification similar to its PAMs certification application. The Board will review this at the 2/23 task force meeting. The Board is also seeking a Consultant on the practice of Dry Needling.
Additionally, TNOTA is watching several bills currently moving through the TN General Assembly. You can read more about what we're tracking on our legislative updates page!


OT Licensure Compact Update: April 20, 2022

With the help of our lobbyists and our friends at the Tennessee Association of Audiology and Speech and Language Pathologists (TAASLP), TNOTA has successfully passed legislation (SB1848) to enact the OT licensure compact in Tennessee! The bill was signed by Governor Lee on April 19, 2022. TNOTA is the 19th state to enact compact legislation. We are excited to join with other states to advance work on Compact Rules. Follow along on our progress at for updates to this important process! Thanks to Senators Watson, Crowe, Hensley, & Reeves, and Rep. Terry for sponsoring this bill in TNOTA. Thanks also to AOTA & NBCOT for their continuous support in this process. 


Telehealth Bill Update: March 2022

Updated March 22, 2022:
Exciting News! TNOTA has been hard at work advocating for the passage of a telehealth bill which would make permanent our ability to practice telehealth! Further, this bill would require all insurance plans to cover telehealth services in TN. The bill has passed through both chambers and is awaiting the Governor’s signature! See more information here!


TN Rules Update: January 2022

The Tennessee Occupational Therapy Licensure Board's proposed rule change regarding continuing education renewal cycles was formally adopted. This proposal amends the renewal cycle for licensure to change to measure CEUs on a 24-month cycle (not calendar year) leading up to the license renewal date. OTs/OTAs will be required to participate in a minimum number of continuing competence activities during the 24 months that precede the licensure renewal month. The renewal cycle will begin on the first day of your birthday month and continue to the last day of the month preceding your birthday month.

Example: If your license is due to be renewed in May 2022, you need to have the requisite number of CEUs for renewal in the 24 months before renewal, from May 2020-April 2022.

There are no changes to the number or type of continued competence activities required for licensure.

The Rule Change requiring all OTRs to complete a minimum of 2 hours of suicide prevention training every 4 years was also formally adopted.

Federal Advocacy Update: January 2022

Download the Federal Advocacy update for January, written by our Legislative Chair, Dr. Susan McDonald. Highlights include information on OTs opening Medicare Home Health Cases, changes to the Medicare Physician Fee Schedule, support for OT Assistants focused on reducing the payment cuts for OTA services, and updates on the Allied Health Workforce Diversity Act. 


Federal Advocacy Update: August 12, 2021

CMS Releases CY 2022 Medicare Part B Proposed Payment Rule

The Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2022 Medicare Physician Fee Schedule (MPFS) Rule and Fact Sheet on July 13, 2021. Below is an outline of some of the key changes that have implications for occupational therapy practitioners in FY 2022, followed by more information on each. 

CMS proposes to:

  • Impose additional cuts to reimbursement for therapy services
  • Finalize the OTA modifier payment reduction
  • Correct a practice expense issue with the OT evaluation codes
  • Extend the telehealth Category 3 codes until the end of 2023
  • Seek comment on the continuation of direct supervision via audio-visual communication
  • Propose therapists cannot use new remote therapeutic monitoring codes

Cuts to Therapy Services

In the proposed rule, CMS did not mitigate the cuts set to return in 2022 stemming from the 2021 Evaluation and Management code changes. With the additional 3.75% funding Congress provided for 2021 coming to an end, the conversion factor for the 2022 fee schedule is dropping to $33.59 from $34.89 in 2021. These cuts will be in addition to the 3% cut already taken from 2020 fee schedule rates and will vary for practitioners, based on code usage and differences in locality. AOTA, along with a large coalition of health care providers, will continue to advocate with Congress and CMS to provide solutions to stop Medicare cuts.

OTA Modifier

CMS is finalizing its policy that a 15% reduction will apply to all services billed with a CO modifier indicating the service was performed all or in part by an occupational therapy assistant, effective January 1, 2022. As a result of a series of AOTA-initiated meetings with CMS officials earlier this year, CMS also provides additional guidance on the application of the modifier. AOTA, along with APTA, advocated with CMS to urge agency officials to correctly incorporate the 8-minute rule into the de minimus standard calculation. CMS agreed with our recommendations, and the rule now does not apply when the therapist performs at least 8 minutes of the last unit of service. 

Additional guidance on applying the modifiers will be forthcoming from AOTA Regulatory staff on the AOTA website and as part of the Summer Series webinars in September. AOTA continues to advocate with Congress and CMS to minimize the effects of this payment policy.


OT Evaluations Practice Expense

As a result of AOTA advocacy, CMS addresses an error in the computation of indirect practice expense for the OT evaluation codes that resulted in lower relative value units (RVUs) in 2021. CMS has proposed a solution, and the correction will result in an increase in reimbursement to the evaluation codes in 2022.

Telehealth Codes

Based on the advocacy of AOTA and partner therapy stakeholders, CMS is proposing to extend the Category 3 telehealth code list, which includes therapy codes, until December 31, 2023. The list is currently set to terminate at the end of 2021, so this will allow additional time for legislative and regulatory advocacy to get the therapy code set made permanent telehealth codes.

Direct Supervision Via Audio-Visual Communication

CMS is seeking comment on whether or not direct supervision by audio-visual communication should become a permanent policy. Currently, the change in direct supervision requirements that was implemented for the public health emergency (PHE) is scheduled to end at the end of the year.

Remote Therapeutic Monitoring

CMS reviewed five new remote therapeutic monitoring CPT® codes for payment. Even though these codes are meant to be billed by nonphysician health care professionals, CMS decided that based on the similarities to remote physiologic monitoring codes, the services cannot be billed by therapists as constructed. CMS is seeking comment on how to remedy the issues with code construction so that nonphysician practitioners may bill the codes.

Quality Payment Program Merit-Based Incentive Payment System (MIPS)

CMS has proposed that the MIPS Value Pathways (MVPs) program will begin in 2023. They introduced seven MVP options for the first year that include rheumatology, stroke care and prevention, heart disease, chronic disease management, emergency medicine, lower extremity joint repair, and anesthesia. CMS is proposing to sunset traditional MIPS reporting and require reporting of only MVPs starting in 2028.

Category weighting for traditional MIPS will change with an increase in the cost category to 30% and a decrease in the quality category to 30%. Five new cost measures have been added, but none are attributable to occupational therapy, so the cost category will once again be reweighted. Additionally, CMS is proposing to continue to reweight the promoting interoperability category for performance year 2022.

AOTA will continue to analyze the proposed rule and share relevant policy changes. AOTA is developing a comment letter regarding CMS’ proposed policies and encourages you to comment as well. Stay tuned for more information on our ongoing advocacy efforts with CMS and Congress.  



Delay the OTA Payment Differential: Advocate & Make Your Voice Heard!

The Medicare Physician Fee Schedule (MPFS) proposed rule includes finalization of the therapy assistant modifier payment differential, which will reduce Medicare payments made to occupational therapy assistants (OTAs) by 15% in 2022.

Make your voice heard—the time to act is now.

The proposed rule is open for public comments, and every comment letter the Centers for Medicare and Medicaid Services (CMS) receives makes a difference. To simplify the process for practitioners, AOTA has created a template letter for you to respond to the proposed rule by telling CMS to delay the OTA payment differential and allow therapy CPT codes to be billed via telehealth under the PHE to be included as Category 3 telehealth codes while we advocate with Congress for telehealth permanence. Comments are due by September 13, and can be submitted at You can access the proposed rule regulation by accessing the Rule document and then clicking the “Comment” button on the top left side of the page and following the directions. Download the four-page Word document below.

Comment Letter Template

AOTA takes action.

In addition to submitting detailed fee schedule comments, AOTA has signed on to a joint association letter to Congress asking for relief from the OTA differential. In the letter, AOTA along with the American Physical Therapy Association (APTA), the National Association for the Support of Long Term Care (NASL), and the National Association of Rehabilitation Providers and Agencies (NARA), ask Congress to delay the differential until 2023, exempt rural and underserved areas from the payment reduction, and request general supervision of OTAs in private practice. 

AOTA has also signed on to a health care organization coalition letter to Congress urging them to reinstate the 3.75% increase to the fee schedule for 2022 and to identify a permanent solution to annual health care cuts by correcting the flawed budget neutrality policy.  



Tennessee Telehealth Update

Updated March 11, 2021


Thanks to the advocacy efforts of TNOTA and our capable legislative sponsors, SB1072/HB1275 by Sen. Bo Watson, R-Hixson, and Rep. Tom Leatherwood, R-Arlington, passed out of both Health committees the week of 3/8/21 with unanimous support. The bill will now head to the respective calendaring committees before being heard of on the floor of both chambers. TNOTA does not anticipate opposition to this bill in the Senate or House.

This legislation updates OT practice settings to include telehealth. If passed, this bill would extend OT practitioners' ability to use telehealth as a service delivery model permanently. If passed, this legislation would eliminate a barrier found within the telehealth bill passed in the August 2020 special legislative session (HB8002/SB8003)-- namely, that OTPs' ability to practice telehealth would end when that bill sunsets in 2022. If this bill passes, OT practitioners would be able to permanently practice telehealth as part of our practice act, though payment parity with in person services is not guaranteed beyond 2022. 

SB1072/HB1275 also acknowledges that OTs may provide a treatment diagnosis to patients, and it allows OTs to perform dry needling of the upper limb, defined as the hand, wrist, elbow, and shoulder girdle.

Once passed, the Board of Occupational Therapy will promulgate appropriate educational requirements to designate these new authorities.  

TNOTA would like to extend our sincerest thanks to our bill sponsors, Senator Bo Watson and Representative Tom Leatherwood, as well as our amazing lobbyists at Capitol & 5th Public Strategies.

TNOTA will keep its members apprised of any movement on the house and senate floors. 

Of note, TNOTA saw unprecedented grassroots advocacy effort surrounding this bill. Several senators and representatives relayed the fact that they heard from OT practitioners in support of this bill-- they heard our message loud and clear. Advocacy works!

On behalf of TNOTA, thank you for your advocacy to help ensure this crucial bill passes!


Dr. Cindy DeRuiter Blackwell, OTD, OTR/L

TNOTA President


Medicaid Block Grant Information

Updated August 15, 2021

Biden to reopen public comment on TennCare block grant

Submit your comment to CMS  

President Joe Biden's administration says it will keep a drastic overhaul of Tennessee's Medicaid program in place while it seeks more public comment and considers what to do with the plan approved under former President Donald Trump.

In a federal court filing this week, Acting Assistant Attorney General Brian Boynton asked a judge to put a lawsuit challenging the TennCare block grant program on hold while the government reopens a 30-day public comment period. The judge signed off on the litigation pause.

The filing says the previous approval of the program under Trump remains in effect during the process. It says the federal government doesn't know yet whether it will reverse or modify the previous decision.

Tennessee is the first state approved to receive lump sum block grant funding for its Medicaid program. But the overhaul's fate remains unclear under Biden. The Democrat who has opposed Medicaid block-grant efforts can rescind the change, but has not taken any action on it to date. Democrats in the state, including U.S. Rep. Jim Cooper of Nashville, have urged Biden to scrap the block grant change.

"While the agency does not yet know whether the new decision will modify that prior approval decision, or the extent of any such modification, the agency believes that this procedure may narrow the issues in the case," the Biden administration's filing states.

In the federal lawsuit, the Tennessee Justice Center and several Medicaid recipients claim the federal government under Trump exceeded its authority in approving the proposal. The complaint also argues Trump's administration failed to provide enough time for the public to provide feedback on the plan.

"Federal officials are now willing to reconsider, and they are inviting the public to comment," said Michele Johnson, executive director of the Tennessee Justice Center. "It is rare that citizens have such an opportunity to affect government policy. That makes it really important that everyone who cares about health care in Tennessee take a few minutes to share their concerns about access to affordable care, medical debt, rural health, care for children with chronic illness or Tennesseans' other health care needs."

A TennCare official on Friday noted that the organization held its own public comment period, but also said its leaders "welcome additional input."

"We are encouraged that CMS' (the Centers for Medicare and Medicaid Services) action in no way delays or prevents implementation of TennCare III, and we remain full steam ahead," said TennCare spokesperson Connor Tapp.

Supporters had pushed for the block grant, claiming it would produce flexibility and savings inside TennCare that would then fuel additional health coverage offerings. Lee, and other supporters, said the new plan would do all of this without cutting benefits or eligibility.

Currently, the federal government pays a percentage of each state's Medicaid costs, regardless of cost increases in any given year. In Tennessee, the government pays 66%, which currently is $7.5 billion of its $12.1 billion Medicaid program.

Republicans argue the current system gives states little incentive to control expenses because no state pays more than half the total cost.

However, Democrats and health advocates have expressed concern that spending caps might cause states to purge their rolls or reduce services. They instead want to expand Medicaid eligibility, which Tennessee's Republican leaders have declined to do under former President Barack Obama's health care law.

Tennessee's General Assembly passed a resolution in 2019 calling for the submission of a block grant plan for federal consideration.

Lee declared in January that Tennessee had become the first state in the nation approved for the plan. Trump's administration signed off on the idea shortly before the president left office.


Updated March 20, 2021

After more than a year of discussions and negotiations with the federal government, Tennessee’s Medicaid “Block Grant” waiver amendment received approval in January by the Centers for Medicare and Medicaid Services (CMS). Tennessee is the first state in the nation to be granted approval for this type of block grant arrangement, which will result in an alternative financing arrangement for its Medicaid program and provide additional flexibilities relative to its administration. While the Biden administration may choose to review approval of this Block Grant and ultimately make changes, that remains to be seen. In the interim, TNOTA's advocacy team is providing resources to help practitioners and consumers understand the changes that this Block Grant structure would bring. 

Block Grant announcement from the state of Tennessee

From the Kaiser Family Foundation: Tennessee & Other Medicaid 1115 Waiver Activity: Implications for the Biden Administration

From the Sycamore Institute: TennCare III: Unpacking Tennessee’s New Medicaid “Block Grant”

From the Center on Budget and Policy Priorities: The Problems with Block-Granting Entitlement Programs

TNOTA will continue to monitor the status of this Block Grant and post regular updates as they become available. 


Telehealth Insurance Coverage 

 With the passage of the Tennessee telepractice bill, most healthcare providers' telehealth services are required under the new law to be covered similarly to in-person services. However, due to some of the bill's language, this is not guaranteed for occupational therapy practitioners at this time. TNOTA is working with our lobbyists and others to help rectify this language difference in order to ensure payment parity for our telehealth services. Watch this space for updates as the situation evolves. 


While some insurance providers are covering OT services via telehealth, this varies based on provider rules. TNOTA's advocacy team has compiled a current list of telehealth coverage in Tennessee, updated 7/6/2021. This document includes link to contact insurance providers who have not yet covered telehealth services. This list will be updated as changes are made.


Blue Cross & Blue Shield of Tennessee announced on May 13, 2020 that they will now cover telehealth, including OT, permanently!


The Centers for Medicare & Medicaid Services (CMS) announced the long awaited news on April 30, 2020 that occupational therapists, physical therapists, and speech language pathologists can now perform telehealth services for Medicare beneficiaries.

Read more on AOTA's website. 


TNOTA's Lobbyists: Working for you!

TNOTA employs a lobbying firm that closely monitors legislation and executive orders from our Tennessee government.

Read the latest update from Capitol & 5th Public Strategies.



Find your legislators

To better inform yourself on issues that affect the provision of OT services in Tennessee, find your legislators and see where they stand on issues that impact our profession.



Other Templates

Letter of Medical Necessity