The Balanced Budget Act (P.L. 105-33) make significant cuts to Medicare and causes massive disruption to occupational therapy. Changes included moving to a prospective payment system for inpatient rehabilitation facilities, home health, and skilled nursing facilities; expanding the cap on private practitioners to therapy in all settings, except hospital outpatient departments, at $1,500; and placing all Part B payment for therapy under the Medicare Physician Fee Schedule. The BBA also creates the State Children's Health Insurance Program (SCHIP). The Individuals With Disabilities Education Act Amendments of 1997 (P.L. 105-17) retains occupational therapy as a related and primary service in all programs. Florence Clark et al. publish in the Journal of the American Medical Association about the benefits of OT programs to “mitigate against the health risks of older adulthood.”