Creative Arts in Therapy

I recently took some time to read the Affordable Health Care for America Act* (also formerly referred to as “H.R. 3962” and commonly called “the health care bill”). While complementary and alternative medicines are underrepresented within the H.R. 3962 law, there are sections therein, which could potentially impact music therapy research and practice (even if only indirectly). In an effort to share the likes of this potential impact, I have provided synopses of several sections from the H.R. 3962 law, along with explanations, of how these sections might affect us as music therapists. So long as no segments of the H.R. 3962 law are repealed in the near future, I feel that the following information will be helpful to music therapy students, interns, clinicians, and educators nationwide.

1. Incentives for Work-based Wellness** Programs

Effective July 1, 2010, employers with 100 and fewer employees will be eligible to apply for grants to support wellness programs for staff members. Receipt of these grants will involve a qualification process, and will be awarded through the Secretary of Health & Human Services and the Secretary of Labor. These awards are intended to support employee wellness programs involving “Health Awareness”, “Employee Engagement”, and “Behavioral Change”. Since board certified music therapists are trained in behavior modification, I believe that we may be able to develop a niche within the “Behavioral Change” component of these funded wellness programs.

If employers are willing, grant funds could potentially be utilized to contract music therapy services to address health areas identified within the H.R. 3962 law. This could specifically involve interventions for physical fitness/obesity (perhaps through music & movement interventions), depression/stress management (perhaps with music assisted relaxation, song writing, and/or lyric analysis), and mental health promotion (perhaps through improvisation). In order to act on this possible opportunity, music therapists will need to consult with local employers to assess awareness of - and receptivity to - the contribution we could make to employee wellness. We will also need to familiarize ourselves with the relevant legislation. Anyone interested in learning more (about these qualified wellness grants, amounts to be awarded, and application eligibility) can refer to pages 62-69 of the H.R. 3962 law.

2. Grants for Continued Education in the area of Autism Spectrum Disorders

Effective beginning in 2011, grants will be available to entities that provide interdisciplinary services for persons on the autism spectrum. Specifically, these grants will be awarded through the Secretary of Health and Human Services, and will be used to fund training and continued education for parents, vocational professionals, educational professionals, and allied health professionals (like music therapists) who work with individuals with autism. In addition, these grants will also be used to fund technical assistance, service improvement, and to address previously unmet needs for people with autism. Such financial assistance would be helpful to music therapists as it could be used to augment the services we provide for people on the autism spectrum. More specifically, if music therapists’ employers were to win one of these grants, the resulting funds could be used to finance autism related Continued Music Therapy Education credits or assistive technologies (and perhaps even adaptive instruments) which could help to enhance the care we provide for our clients. In order to access funds from this program, music therapists working in organizations serving individuals on the autism spectrum can encourage their employers to explore options for gaining grant award eligibility. For specific information about Autism grants, or to learn if your place of employment is eligible for these grants, see pages 1402-1412 (ending on line 14) of the H.R. 3962 law.

3. Grants for Prevention*** and Wellness Research Initiatives

Starting in 2011, grant funds will be available to entities conducting research in the areas of prevention and wellness. Bodies eligible for these funds will include consortiums and non-profit entities (which the American Music Therapy Association happens to be). Access to such funds could enable the American Music Therapy Association to further develop the body of research which makes up our evidence base. There is a catch. Research funded by these grants must focus on prevention and wellness priorities that have not yet been identified by the Secretary of Health and Human Services. The good news is that a set of prevention and wellness priorities will be identified (by the Secretary of Health and Human Services) by April 1, 2011. Should these priorities include areas such as stress reduction, coping skills, or pain management, I believe that the American Music Therapy Association will be eligible to apply for the respective research grants. During the next several months, the American Music Therapy Association’s Government Relations committee may be able to submit suggestions (to the Secretary of Health and Human Services) regarding clinical areas that should be regarded as prevention and wellness priorities. This can be approached through communications with the Task Force on Clinical Preventative Services (whose membership has not yet been assigned, but will consist of individuals who are responsible for recommending prevention and wellness priorities to the Secretary of Health and Human Services). For complete information about prevention and wellness research grants, see pages 1286-1291 (ending on line 6), and 1305-1308 (ending on line 15) of H.R. 3962 law.

4. Reimbursement

In an effort to ensure the availability of affordable health care coverage which offers (at the very least) “essential benefits” for all consumers, updated Standards for Qualified Health Benefits Plans have been incorporated into the H.R. 3962 law. Some of these standardized essential benefits include coverage for hospitalizations, prescription drugs, durable medical equipment, and maternity care. These essential benefits also include habilitation services. Initially, one might assume that music therapy can be classified as a habilitation service when appropriate but presently, the H.R. 3962 law does not contain a clear explanation of what is or is not considered a habilitation service. Fortunately, the H.R. 3962 law does contain a requirement for the development of a Health Benefits Advisory committee which will be responsible for defining (among other things) all of the services contained within the essential benefits package-including habilitation services. This task must be completed by March 2011. If the Health Benefits Advisory committee were to determine that music therapy could be considered as a habilitation service, then it could become possible to achieve more consistent reimbursement for music therapy services under the essential benefits coverage. Of course, this will not happen automatically. The Health Benefits Advisory committee will need to be made aware of the benefits of music therapy in wellness care. The committee will also need to be made aware of the research that supports music therapy in wellness care. Relevant music therapy research will be of particular importance because the Health Benefits Advisory committee is bound by the H.R. 3962 law to only investigate services that employ evidence-based practices. Similarly, the committee is also bound by the H.R. 3962 law to “allow for public input as a part of developing recommendations…” In order to take advantage of this reform component, music therapists, music therapy supporters, and music therapy leadership will need to ensure that relevant resources and research materials are available to the Health Benefits Advisory committee for consideration. Such an initiative could be spearheaded by the American Music Therapy Association’s Government Relations Committee. For further information about essential benefits packages, or the role of the Health Benefits Advisory committee, see pages 15 (lines 1-9), 89-90, and 103-109 of the H.R. 3962 law.

5. Private Practices

Effective beginning in 2014, small businesses (such as music therapy private practices) who offer employer-based health care coverage for their staff will be eligible for tax credits. Specifically, music therapists whose practices consist of fewer than 25 full time employees (whose average earnings are less than $50k per year) may receive a tax credit for a percentage of the cost of providing health insurance to employees. The size of these credits will be calculated according to the number of employees covered, and the average yearly earnings of those employees. As an additional note, music therapy private practice owners who contribute to employees’ health care coverage may soon be required to submit reports to the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health & Human Resources, and/or the Secretary of Treasury. Details about this process are scheduled to be made available (via website) by July 2010. To monitor the status of this website’s completion, visit healthreform.gov. In the meantime, for more information about employer health care coverage, and reporting responsibilities, see pages 268- 317 (ending on line 18) of the H.R. 3962 law. For additional information about tax credits, see page 317 of the H.R. 3962 law or visit http://www.irs.gov/newsroom/article/0,,id=223666,00.html.

6. Education/Exposure Initiatives for High School Students

Among other responsibilities, the Secretary of Health and Human Services may develop an initiative intended to facilitate high school students’ interest in and awareness of career opportunities in health care. While this initiative does not have an effective date, and is not described as mandatory within the H.R. 3962 law, if implemented, such a program would require that the Secretary of Health and Human Services issue grants to allow eligible entities to create high school health sciences career curricula. These curricula would include courses such as biology, nutrition, and “…other courses deemed appropriate by the Secretary to prepare students for associate’s or bachelor’s degrees in programs in health professions or bachelor’s degree programs in health processions-related majors…”

Entities which are eligible to contribute to such curriculum include educational agencies and accredited health professions schools. I believe that such schools and agencies include universities where music therapy degree programs are housed. As such, music therapy university programs may be able to receive grants to create and submit curricula recommendations geared towards teaching high school students about careers in music therapy. If successful, such an effort could result in increased awareness of music therapy, increased interest in music therapy as a career choice, increased enrollment in music therapy undergraduate programs, and (eventually) increased numbers of music therapists entering the field. As mentioned before, however, the high school exposure program is not described as mandatory. Developments in this initiative will need to be monitored (perhaps by the American Music Therapy Association’s Government Relations committee) to determine when grants might begin to be awarded. For more information about health career education for high school students, and grants for curricula, see pages 1437-1440 (ending on line 4) of the H.R. 3962 law.

7. Digital Documentation

The Secretary of Health and Human Services has been assigned the task of investigating implications for the utilization of electronic health records. This will specifically include a study of potential costs associated with electronic health records, reasonable methodology for using electronic health records, possible effects of electronic health records use on reimbursement rates, employee training required to implement electronic health records use, and assistance required for health care providers to implement electronic health records. The results of this investigation are due no later than December 2013. Pending the contents of said report, music therapists (along with other health care professionals) may be required to learn and start applying digital documentation. It may be too soon to tell what the impact of such a change might be, but prior knowledge of this looming alteration could afford us the potential for a smoother transition. For more information about the electronic health records investigation, see pages 153-154 of the H.R. 3962 law.

Deep within its hundreds of pages, the H.R. 3962 law contains language that could result in major opportunities for music therapy (such as access to federal funds for music therapy research, continued education, and new music therapy contracts). None of these opportunities can be capitalized upon, however, unless we make a deliberate effort to take advantage of them. I would like to encourage music therapists, music therapy supporters, and music therapy leadership to visit healthreform.gov to start learning more about the latest updates in health care legislation. Talk to one another. Ask questions. Discuss provisions in the H.R. 3962 law during state task force and peer supervision meetings. Become aware of the information available, then call the American Music Therapy Association to ask how you can use your knowledge of the Affordable Health Care for America Act to help secure music therapy’s place among legitimate health care professions of the future. Your music therapy students’ students will thank you. And I will thank you as well.

I hope that this post will be helpful to readers, and if there are any questions or comments, please feel free to write :O)

Until next time!

Ms. Terel Jackson, NMT, MT-BC

* A PDF version of the Affordable Health Care for America Act can be found at docs.house.gov/rules/health/111_ahcaa.pdf

**Wellness (as described in the H.R. 3962 law) involves health-related services (excluding primary care) which reduce health risks and promote healthy behaviors. These services are indented to prevent disease, reduce the impact of chronic conditions, and provide education regarding personal health maintenance, self-care, and patient decision-making. Wellness areas can include poor nutrition, physical inactivity, obesity, tobacco use, alcohol/substance abuse, injury & violence, risky sexual behavior, untreated mental health problems, and untreated dental & oral problems.

***Prevention (as described in the H.R. 3962 law) involves screenings and other services which are aimed at early detection of illness.