Federal Legislative Issues Update - July 2005
July 2005
Washington News
Congressional activity will come to a close at the end of July as Congress will vacate Washington, DC for 5 weeks of politics and vacation. The last week of July becomes a logjam of legislation being pushed for passage before Congress adjourns on Friday, July 29. Included on the agenda for the end of July are votes on the Central America Free Trade Agreement, energy and transportation legislation, estate tax repeal legislation, appropriations bills, and a number of other issues.
Congressional leaders have dedicated the week of July 25-29 as "Health Week," in an effort to address health policy issues and move forward key pieces of legislation in the House and Senate. Health Week is a good opportunity to engage and discuss the therapy cap repeal legislation, quality, funding, and research issues facing you and your profession. As part of Health Week's legislative agenda, Congress plans to address many health-related issues including association health plans (see below), stem cell legislation, and Medicaid.
See below and watch the Legislative Action Center for opportunities to become involved with your elected representatives over the August recess.
AOTA To Make a Grassroots Push for Therapy Cap Repeal During the August Congressional Recess
Every year Congress goes into recess during the month of August, but the work of advocacy and pressure to affect change doesn't stop. This year AOTA is organizing a significant grassroots effort to have members contact Senators and Representatives in their home districts and educate them about key health care issues important to occupational therapy.
The specific targets this year are the Senators from your state. We are asking that you look for e-mail alerts and check with the Legislative Action Center to stay informed and take action regarding repeal of the therapy caps. AOTA is lobbying aggressively for a resolution to the problem of the Medicare Part B cap which, without Congressional action, will go back in effect January 1, 2006. The AOTA Federal Affairs Department has been meeting with members of Congress and their staffs regularly over the past few months to discuss the Medicare Access to Rehabilitation Services Act of 2005 (S. 438/H.R. 916), and the number of cosponsors are climbing, but not fast enough. While there are only a few of us, there are hundreds or thousands of YOU in every state, so we need your help.
Largely, we are asking for you to call your Senator's office and ask for a meeting with the Senator or their staff member in the district handling health care issues to discuss the therapy caps and the importance of protecting patients and professionals. The e-mail and Legislative Action Center will give you all the information you need to be an effective advocate.
We know this is a big commitment but this is a big issue that we have to resolve before the end of the year when the caps will be enforced unless Congress takes action.
Appropriations Bills Move Forward
The Senate Appropriations Committee on July 14 voted to restore funding for the majority of Title VII health professions programs and to give the National Institutes of Health (NIH) a $1 billion increase over the current year's level (read more about the NIH below). While the House of Representatives Labor-HHS-Education bill eliminated most Title VII programs, the Senate bill provides $298.7 million for Title VII health professions in FY 2006, an $820,000 (0.3%) increase over FY 2005. Title VII of the Public Health Service Act authorizes a variety of grants for students, programs, and institutions to improve the racial and ethnic diversity, geographic distribution, and quality of the health care workforce. The Labor-HHS-Education Appropriations Conference Committee-a committee of House and Senate leaders-will reconcile the House and Senate versions of the bill in the coming weeks. Watch the Legislative Action Center for any new developments.
Most importantly, some key issues for occupational therapy were highlighted. AOTA also secured report language in the Senate version of the Labor-HHS-Education Appropriations bill to provide direction to the Health Resources and Services Administration (HRSA), which has authority over Maternal and Child Health grants. The language encouraged that agency to "identify a competitive category specifically for pediatric occupational therapy training grants in 2006." This is a great victory as Maternal and Child Health stopped funding occupational therapy focused grants a few years ago. The report also asked the Department of Education to use funds to address shortages of occupational therapists "available to work in school systems" and available as "leadership-level faculty to train such professionals." AOTA will lobby these agencies to implement this language in FY2006.
IDEA Proposed Regulations
The U.S. Department of Education concluded the latest round of public meetings to solicit comments on the proposed regulations for the 2004 amendments to the Individuals with Disabilities Education Act (IDEA). Proposed regulations were published and meetings were held in 7 cities, including Washington, DC in June and July; occupational therapists and occupational therapy assistants attended many of these meetings and made verbal comments using talking points developed by AOTA. Kelly Potter, OTS, who is completing a fieldwork assignment in AOTA's Public Affairs division, spoke at the Washington, DC meeting about the need for clarification of the "highly qualified" requirement for occupational therapy practitioners, the inclusion of OT as an early intervening service, and the importance of professional development for effective occupational therapy service delivery.
AOTA members still have until September 6, 2005 to provide written comments to the Department on these proposed regulations. Contact Federal Affairs if you have questions about IDEA or the proposed regulations at fad@aota.org.
Other Department of Education News
Joan Mele-McCarthy, special assistant to John Hager, Assistant Secretary of Education, Office of Special Education and Rehabilitative Services (OSERS), has announced her resignation from OSERS. Joan, who is a speech-language pathologist, was a strong advocate of related services within OSERS and good friend to AOTA. She will be missed. Federal Affairs staff will continue to work with the Department to ensure occupational therapy interests remain on the agenda.
Family Opportunity Act
Senator Ted Kennedy (D-MA) continues to advocate for passage of the Family Opportunity Act. Watch the AOTA Legislative Action Center at http://capwiz.com/aota/home/ for an updated fact sheet and how you can help advocate for passage.
White House Conference on Aging (WHCoA) Mini-Conference on Disability and Aging
Occupational therapist Adel Herge, of Thomas Jefferson University and the chair of AOTA's Developmental Disabilities Special Interest Section (DDSIS) attended WHCoA Disability and Aging Mini-Conference on behalf of AOTA. Bill Mann, chair of the occupational therapy program at the University of Florida, also attended. The Mini-Conference was cochaired by AARP, the American Association of People with Disabilities, America's Health Insurance Plans, and the National Institute of Disability and Rehabilitation Research (NIDRR) at the U.S. Department of Education. The 2-day conference focused on the intersection between disability and aging and the implications for employment and social engagement, economic security, long-term care, and assistive technology and universal design. AOTA representatives participated in workgroups on social engagement and assistive technology to develop specific recommendations for consideration by WHCoA delegates at their December meeting.
American with Disabilities Act
The Americans with Disabilities Act turns 15 on July 26, 2005. AOTA recently signed onto a statement of solidarity to commemorate the anniversary. Read the Statement at http://www.aapd-dc.org/News/adainthe/solidarityada.html.
Association Health Plans
Association Health Plan (AHP) legislation has circulated around Congress for several years now. The idea is simple, but the details can become complicated. Essentially, the objective of AHPs is to give associations or groups of small employers and individuals the ability to come together and use their increased purchasing power to obtain lower cost health insurance. This certainly seems to be worthwhile on the surface but problems can potentially arise in the administration of the association health plans. Problems can include inadequate oversight, especially because state insurance laws are exempted, barriers to access for higher risk groups, and financial solvency of the plans. AOTA is concerned that under this legislation, AHPs do not have to offer coverage of state-mandated benefits, which could deny beneficiaries proper care.
The House of Representatives has passed this legislation in previous Congresses, but the Senate has not taken up the issue and therefore it hasn't become law. This week, the House of Representatives passed The Small Business Health Fairness Act of 2005 (H.R. 525), this Congress' version of an AHP bill. The Senate is also looking to see if they have the necessary number of votes for passage of the (companion) Senate bill (S. 406) introduced by Senator Olympia Snowe (R-ME).
AOTA supports programs to reduce the number of uninsured and to improve access to health care but not at the expense of particular at-risk populations or by giving up essential protections and coverages. AOTA will continue to work with Congress on this issue and monitor progress to help ensure that essential safeguards, including protections for consumers and access issues, are adequately addressed in any legislation that may become law.
Pay for Performance
These are the new buzz words in regard to health care reform and the AOTA Federal Affairs Department is watching to see how this issue will affect Medicare and occupational therapy.
Pay for Performance is a proposed change in the way Medicare reimburses doctors and others, including occupational therapists, for the care they provide. The current system is a fee-for-service plan where physicians and providers get paid based upon the specific tests, exams, and procedures they perform rather than on the subsequent results or effects on the patient. Fee-for-service pays for the number of activities undertaken rather than the quality or outcomes of those interventions. Pay for Performance is intended to change that by providing an incentive for physicians and practitioners to use evidence-based practice, improve efficiency, and have better patient outcomes.
Senate Finance Committee Chairman Charles Grassley (R-IA) recently introduced the Medicare Value Purchasing Act of 2005 (S. 1356), which lays out the framework for a Pay for Performance policy. The purpose of the bill is to link a percentage of Medicare payments for physicians, hospitals, health plans, skilled nursing facilities, home health, and end stage renal disease facilities to quality measures. The Secretary of Health and Human Services would be given the authority to select measures of quality to be used for each program for the different providers.
House Ways and Means Health Subcommittee Chairwoman Nancy Johnson (R-CT) plans to unveil her plans for Pay for Performance before Congress adjourns for the August recess.
The bill includes a potential boom for occupational therapy. New reports on functional status will be required to be done for all SNF patrons on admission and discharge. Occupational therapists are excellently positioned to complete these assessments.
Health Care Information Technology
Another important aspect of Pay for Performance is how it is being linked to a push toward improving the use of information technology in health care. There are currently three bills in the Senate that address this issue. Part of the Pay for Performance idea is to give incentives to use health care information technology in order to make care more efficient and to make health care records more useful and available to the range of professionals treating a patient.
These developments are important to occupational therapists for two significant reasons. First of all, changes that improve the efficiency of Medicare affect patient care as well as the overall budget of the program. Secondly, the aspects of the program being applied to physicians and practitioners will affect practice patterns and methods.
AOTA will continue to monitor the progress of both Pay for Performance legislation as well as efforts to enhance health care information technology.
Medicaid Commission Decided
Health and Human Services Secretary Mike Leavitt today announced 13 voting members and 15 nonvoting members of an advisory commission charged with identifying reforms and giving recommendations as to where to find $10 billion in savings in the Medicaid program. The commission's first meetings will be on Wednesday, July 27. To view the members of the commission go to http://www.os.dhhs.gov/news/press/2005pres/20050708.html. The commission's recommendations are due to Congress on September 1, 2005. Congress plans to move forward with the FY2006 budget resolutions reconciliation instructions on September 15.
Watch the Legislative Action Center for more details as they become available.
Update on the 75% Rule
Senators Ben Nelson (D-NE) and Rick Santorum (R-PA), and Representatives Frank LoBiondo (R-NJ), Nita Lowey (D-NY) and John Tanner (D-TN) introduced the Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005 (S. 1405/H.R. 3373) on July 14 and July 21, respectively. The Centers for Medicare and Medicaid Services (CMS) recently implemented a regulation known as the 75% Rule for Inpatient Rehabilitation Facilities (IRFs), requiring that a percentage of patients, increasing over the next few years up to 75%, must be treated for 1of 13 specific conditions identified in 1984 in order for a facility to retain IRF status. This fails to take into account medical advances of the past two decades. IRF status gives the hospital the ability to receive adequate Medicare compensation due to the intense rehabilitation services that are provided.
The recently introduced legislation will maintain for 2 years a 50% threshold used to determine whether a hospital or hospital unit qualifies as an IRF under Medicare. The 50% threshold expired this month and is scheduled to increase to 75% over the next 2 years. The bills also establish a National Advisory Council on Medical Rehabilitation to recommend to Congress and the Department of Health and Human Services how to update the rule to ensure it is clinically appropriate.
AOTA has expressed concern about current implementation that many arthritis-related conditions were not included in the "75%" list, that the list did not reflect current trends in rehabilitation, and that ultimately the narrowing was in direct conflict with what practitioners see as a need for more utilization of rehabilitation hospitals. AOTA will continue to work on Capitol Hill with other organizations to obtain Congressional support for changing the 75% rule.
Watch the Legislative Action Center for an Action Alert to contact your Member of Congress and ask for their support for the Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005.
Federal District Court Dismisses "Incident To" Case
The National Athletic Trainers' Association (NATA) filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) regarding enforcement of new rules requiring that "incident to" therapy services for Medicare beneficiaries be provided by qualified providers, which include only occupational therapists, physical therapists, and speech-language pathologists. A federal district court on Thursday, July 21, dismissed NATA's lawsuit against CMS, finding it does not have jurisdiction to consider the case.
"Incident to" therapy is therapy billed under the physician's provider number as if the physician had performed the service. Prior to the change in policy, Medicare covered therapy services by non-therapists, such as low vision specialists and athletic trainers, provided they complied with the "incident to" rules (e.g., were furnished under the physician's supervision while the physician was present in the office suite).
AOTA will continue to monitor the issue and report using the Legislative Action Center as soon as information is available.
National Institutes of Health Reauthorization
Chairman Barton of the Energy and Commerce Committee is drafting legislation to reauthorize the National Institutes of Health (NIH). The AOTA Federal Affairs Department is monitoring this process and its potential impact upon research related to occupational therapy.
The NIH is one of the world's foremost medical research centers. The NIH is comprised of 27 separate institutes and centers that are responsible for acquiring new knowledge to help prevent, detect, diagnose, and treat disease and disability. Research conducted by NIH is often valuable to many areas of medicine at once, but research specifically target toward rehabilitative care is housed under the National Institute of Child Health and Human Development.
Developments to this point have included statements that both give rise to hope and concern in regard to the impact the draft legislation might have when it is finally introduced. AOTA's concerns surround a change in the amount of authority the director of NIH can have to redirect funding to areas of either medical crisis or opportunity and how that might negatively affect occupational therapy research. On the positive side, Director Zerhouni stated in his testimony before the Energy and Commerce Health Subcommittee that he believes more attention should be paid to chronic illness rather than acute care, a statement which has potential benefits for occupational therapy research and practice. AOTA has reviewed the draft legislation circulated by Chairman Barton and will continue to monitor any changes impacting occupational therapy interests. Continue to watch the Legislative Action Center for alerts related to NIH.
STOP Stroke Legislation
The Stroke Treatment and Ongoing Prevention Act of 2005 (S. 1064/H.R. 898), or the STOP Stroke Act, was recently introduced in the Senate on June 18, 2005, by Senator Thad Cochran (R-MS). Representatives Charles "Chip" Pickering (R-MS) and Lois Capps (D-CA) introduced the House of Representatives companion bill on February 17.
The legislation aims to ensure that stroke is more widely recognized by the public and treated more effectively by health care providers. The bill is focused on "macro-level" changes and does not provide funds for direct patient care. The bill will help raise public awareness about stroke; provide critical resources to implement stroke care systems; establish a clearinghouse to collect data and share best practices; and offer medical professional development programs in new stroke therapies. AOTA participates as an active member in the STOP Stroke Coalition, working to address the nation's number three killer and a leading cause of long-term disability.
AOTPAC Update
The American Occupational Therapy Political Action Committee (AOTPAC) will continue to work to raise funds, and ask that you please be responsive. Contact Darlene Dennis at AOTA in regard to contributions, questions, or comments about AOTPAC.
Do you have a grassroots advocacy story to tell? Do you know or have a connection to your Senators or Representatives? Contact AOTA's Federal Affairs Department and share your experience! E-mail: fad@aota.org, Mail: PO Box 31220, Bethesda, MD20824-1220 , Telephone: 800-729-2682, or Fax: 301-652-7711.
7/27/05