Federal Legislative Issues Update - June 2005
June 2005
Washington News
Congress will begin a busy legislative schedule after the Independence Day recess on July 11. They will be in session for 3 weeks before the August recess. On the legislative agenda for July are more Medicaid hearings, energy legislation, transportation and highway legislation, and appropriations bills. AOTA urges all occupational therapists, occupational therapy assistants, students of occupational therapy, and beneficiaries to remain in contact with your elected representatives during these 2 months. Occupational therapy providers and beneficiaries have important issues in front of Congress and your voice needs to be heard!
Medicaid Developments
House Energy and Commerce Committee Chairman Joe Barton (R-TX) vowed to continue hearings on Medicaid reform until the beginning of the August recess. On June 15, House Energy and Commerce Chairman Barton and Senate Finance Chairman Charles Grassley (R-IA) held a hearing with Chairman Mark Warner (D-VA) and Vice Chairman Mike Huckabee (R-AK) of the National Governors Association (NGA) testifying on how to rein in the growth of Medicaid. Medicaid covers 50 million people with costs that exceed $300 billion a year, a 63% increase in spending in the last 5 yearsBoth Governors presented a bipartisan proposal on behalf of the NGA that focused on allowing states to change co-payments to beneficiaries and receive larger discounts from drug companiesThe governors also said state officials should be able to establish different benefit packages for different Medicaid recipients, and Congress should limit the court's ability to issue consent decrees and other orders that affect Medicaid.
The Senate Finance and House Energy and Commerce Committees will mark up their proposed budget cuts, including $10 billion from Medicaid, for inclusion in the reconciliation bill by September 16. As directed by the FY 2006 budget resolution, U. S. Department of Health and Human Services Secretary Mike Leavitt is convening a Medicaid commission that will be asked to make recommendations by September 1, 2005, for achieving $10 billion in Medicaid savings. Second, the commission is expected to issue a more comprehensive report on long-term changes to the program by December 31, 2006. Continue to watch the Legislative Action Center at http://capwiz.com/aota/home/ for further developments in the Medicaid debate.
New GAO Reports on Medicaid
As the Senate begins hearings on reforming the Medicaid program, the U.S. Government Accountability Office (GAO) released three reports that should be of interest to occupational therapy practitioners who work with Medicaid beneficiaries. The June 28th reports looked at strategies that states have used to maximize federal funds to finance the state-run programs; two of the reports reflect GAO testimony before the Senate Committee on Finance. Go to http://www.gao.gov/cgi-bin/getrpt?GAO-05-748 to read the report entitled, Medicaid Financing: States' Use of Contingency-Fee Consultants to Maximize Federal Reimbursements Highlights Need for Improved Federal Oversight (GAO-05-748). Testimonies on Medicaid Fraud and Abuse: CMS's Commitment to Helping States Safeguard Program Dollars Is Limited (GAO-05-855T) and Medicaid: States' Efforts to Maximize Federal Reimbursements Highlight Need for Improved Federal Oversight (GAO-05-836T) can be read at http://www.gao.gov/cgi-bin/getrpt?GAO-05-855T and http://www.gao.gov/cgi-bin/getrpt?GAO-05-836T respectively.
Eliminating the Therapy Caps Remains at the Top of AOTA's Legislative Agenda
The Federal Affairs Department recently issued a challenge for AOTA members to contact Congress in support of the Medicare Access to Rehabilitation Services Act of 2005 (S.428/H.R.916) and you responded. In less than 2 weeks, AOTA members generated over 7,200 e-mails and letters to members of Congress. Your continued attention to this crucial issue is essential because the moratorium that currently blocks the caps from being imposed will expire at the end of this year and unless Congress takes action the caps will be in effect as of January 1, 2006. AOTA and coalition members are continuing to increase pressure on Congress to take action and repeal the outpatient therapy caps on Medicare services. We need you to continue your effort and be sure your Representatives and Senators are in support of repealing the caps and increasing access to occupational therapy. Use the Legislative Action Center at http://capwiz.com/aota/home/ to contact your members of Congress, and be sure to watch for important action alerts related to this priority issue.
Home Care Qualifying Service Legislation Introduced
On June 22, Representative Robert Andrews (D-NJ) introduced the Medicare Occupational Therapy Coverage Eligibility Act of 2005 (H.R. 3022). This legislation would make occupational therapy a qualifying service for home care under Medicare lawCurrently, Medicare beneficiaries must receive either skilled nursing, physical therapy or speech-language pathology services before becoming eligible for occupational therapyPassage of this bill would make occupational therapy equal to physical therapy and speech-language pathology services as a qualifying service for Medicare home health services.
The Home Care Coalition, of which AOTA is a major player, is working to support this and a number of other issues related to improving health and support services for people in their homes. Continue to watch the Legislative Action Center at http://capwiz.com/aota/home/ for any updates to this important legislation.
Proposed IDEA Regulations Released
The U.S. Department of Education published its Notice of Proposed Rulemaking (NPRM) for the amended Individuals with Disabilities Education Act (IDEA) in the June 20th Federal Register. The proposed rules cover the Part B state grant and Preschool grant programs, and the Part D personnel development service obligation. The Department is seeking comments from parents, teachers, related services personnel, administrators and other interested parties. The deadline for written comments is September 6, 2005. Comments can also be given at one of the remaining public sessions in San Antonio and Washington, DC.
AOTA staff is conducting a more detailed analysis of the NPRM and will be submitting comments by the deadline. Contact Federal Affairs at fad@aota.org if you have any questions about the amended IDEA or the proposed regulations.
Medicare's New Policy on Supervision of "Incident To" Therapy Services Delayed
The Centers for Medicare and Medicaid Services (CMS) recently changed its regulations and policy with respect to therapy services provided "incident to" a physician's service. Effective on June 6, 2005, Medicare stated they will only cover therapy services furnished "incident to" a physician's service if the services are furnished by physical or occupational therapists or by physical or occupational therapy assistants under the supervision of a therapist. This new regulation applies only to Medicare patients.
"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 therapy assistants 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).
As a result of a May 31 lawsuit filed by the National Athletic Trainers' Association (NATA) against the Centers for Medicare & Medicaid Services (CMS) regarding certified athletic trainers' ability to practice, CMS has delayed the planned June 6 enforcement of new rules requiring that "incident to" therapy services for Medicare beneficiaries be provided by qualified occupational therapists.
Title VII Funding Cut by House of Representatives: Action Needed
In accordance with the President's budget proposal, the House of Representatives eliminated all Title VII health professions funding except for Centers of Excellence ($12 million) and Scholarships for Disadvantaged Students ($35 million) on June 24 in the FY 2006 Labor-HHS-Education Appropriations Bill (H.R. 3010). 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. Labor-HHS-Education Subcommittee Chairman Ralph Regula (R-OH) pledged on the House floor during the appropriations debate to work with the Senate in conference to try and restore these funds.
The U.S. Senate is expected to take up the issue after the Fourth of July recess. It is crucial that the Senate fight to restore Title VII funding which is vital to occupational therapy students and programs around the country. Contact your Senator and ask them to express their support for Title VII programs and urge the Senate Appropriations Committee to restore funding in the Senate version of the bill. AOTA and the Health Professionals and Nursing Education Coalition will continue to work with House and Senate leaders to restore funding to Title VII programs. Use the Legislative Action Center at http://capwiz.com/aota/home/ to contact your member of Congress and voice your support for restored funding to Title VII programs.
Representatives and Senators State Opposition to Medicare's "In the Home" Restriction on Mobility Devices
Representatives Jim Langevin (D-RI) and Charlie Bass (R-NH) received support from 59 other House Members in opposing Medicare's "in the home" restriction on mobility devices. The letter sent to HHS Secretary Mike Leavitt on June 23 asked the Secretary to modify the "in the home" restriction to improve access to the community for people with disabilities.
As the letter explains, Medicare's "in the home" restriction limits coverage of mobility devices to only those that are necessary within the patient's home. A beneficiary, who is able to function at home but needs a mobility device or a more functional mobility device to access his or her community, work, school, physician's office, pharmacy, or place of worship, would not be eligible for a wheelchair—or the right wheelchair—under restriction.
Senators Rick Santorum (R-PA) and Jeff Bingaman (D-NM) are currently circulating a similar letter in the Senate. This restriction threatens the health and independence of people with disabilities and runs counter to the goals of the Americans with Disabilities Act and the "New Freedom Initiative." Continue to watch the Legislative Action Center at http://capwiz.com/aota/home/ for updates to the "in the home" restriction in Medicare.
AOTA Submits Testimony on Youth Suicide Prevention and Post-Acute Care
Youth Suicide Prevention hearing
AOTA submitted testimony in regard to Youth Suicide Prevention to the Senate Indian Affairs Committee after attending the June 15th hearing on the subject. AOTA's testimony relates to ways in which occupational therapists are currently working with youth at elevated risk of suicide on reservations and throughout the country, as well as how occupational therapists could be involved in new initiatives aimed at reducing youth suicide.
Although teen suicide has become an epidemic across the country and represents the third leading cause of death for America's teenagers, the situation is significantly worse among the Native American population. Nationally, the suicide rate of Native American teens is nearly three times the national average and on some Northern Plains reservation, the suicide rate exceeds ten times the national average. AOTA Federal Affairs staff is monitoring legislation that may provide increased opportunity for occupational therapists to provide their leadership and expertise to this important issue.
Post-Acute Care Hearing
House Ways and Means Subcommittee on Health Chairwoman Nancy Johnson (R-CT) held a hearing on June 16 to focus on current financing for post-acute care services in Medicare; the services available across the various post-acute settings; the patient assessment instruments used in each of the settings and the commonalities between them; and prospects and suggestions for moving ahead with a common patient assessment tool and more rational payment system based on beneficiary need rather than institutional setting. AOTA submitted testimony to the subcommittee pointing out the benefits and unique service occupational therapists and therapy assistants provide within post-acute care settings. In addition, the testimony focused on the financial limitations on therapy imposed by Congress in the Balanced Budget Act of 1997 and how it impedes the therapist's ability to provide the most effective and beneficial treatment to his or her patients.
Appointees to The White House Conference On Aging
In the fall of 2005, there will be a White House Conference on Aging. AOTA alerted occupational therapists and encouraged them to write to their Governors and Members of Congress to seek appointment to the conference. Several occupational therapists have already been appointed for this prestigious honor. If you have been appointed and are not on this list, please let us know at fad@aota.org so that we can keep you informed of issues important for the profession: Laura K. Beckman, OTR/L by Senator McCain (AZ); Elaine C. Adams, OTR/L, submitted by Governor Jodi Rell (CT); alternate delegate Linda L. Levy, MA, OTR/L, FAOTA., appointed by Governor Rendell (PA); Janet Menke, OTR/L, appointed by Congressman Jeff Flake (R-AZ); and Leonard Trujillo, PhD, OTR/L and Anne E. Dickerson, PhD, OTR/L, FAOTA. In a press release from the White House, President Bush listed individuals he intends to select to be members of the Advisory Committee to the White House Conference on Aging, for the Life of the Conference. This list included Cynthia Hughes Harris, an occupational therapist from Florida.
Pentagon's 2005 Base Realignment and Closure targets Walter Reed Hospital
Walter Reed , one of the military's most famous hospitals, could face a realignment under the Base Realignment and Closure (BRAC) plan, forcing staff to move to different facilities such as the National Naval Medical Center in Bethesda. Many occupational therapists and therapy assistants have treated hundreds of returning soldiers from active duty with illnesses, injuries, or disabilities at Walter Reed Hospital. All BRAC recommendations must be approved by Congress and the president to take effect. AOTA will continue to watch and report any developments.
Amendment To Limit Mental Health Services to Children Defeated in House Vote
On June 23, the U.S. House of Representatives voted "no" on an amendment offered by Representative Ron Paul (R-TX) aiming to prevent federal funding for screening and early intervention programs targeted to children and adolescents with mental health conditions.
Unfortunately, a child in need of mental health services is often not diagnosed until he or she has experienced failure in school. Parents need to know about any problem interfering with the learning process, whether a hearing loss, a vision deficit, attention deficit hyperactivity disorder (ADHD), or other mental health problem. Screening for vision and hearing is often offered within the school system. Screening for mental health disorders is no different. The Paul amendment was designed to discourage screening and early intervention for any mental health problem.
Supporters of the amendment claim that early screening would undermine parental rights, when in fact, parents will always have the right to control whether their child is screened or given services. Early identification of mental illnesses can prevent a host of problems and can ensure that proper supports are in place. AOTA will continue to work for the inclusion of mental health services in legislation on Capitol Hill.
AOTPAC
Telemarketing efforts have begun to assist the American Occupational Therapy Political Action Committee (AOTPAC) in raising funds. A letter, followed by a call, will be sent to all AOTA members requesting a contribution. Please consider a donation. When you get a call, please know it is on our behalf and legitimate.
Plans are underway for AOTPAC Board Members to participate in state association conferences throughout the year. Watch for details on which state conferences they will be attending.
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.
6/29/05