Federal Legislative Issues Update - May 2005
May 2005
Washington News
At the end of a long, eight-week legislative stretch, Congress passed the half-way point for the first session of the 109th Congress last week. (The end of the session is set for October; however, Congress often works later in the year.) Heading the legislative agenda upon their return on June 7 are budget and appropriations, National Institutes of Health reauthorization, Social Security overhaul, and vocational rehabilitation and other job programs. On the regulatory front, meetings on new proposed regulations for the Individuals with Disabilities Education Act will begin June 12 and end July 17.
A key part of the budget debates will be changes to or savings in Medicare, affecting many occupational therapy issues.
The next few months of the legislative schedule will provide great opportunities for AOTA members to interact with their elected representatives. Congress will be in session through the month of June until they recess for a week for Independence Day. Lawmakers return for three weeks before again recessing for the month of August. They usually use these breaks from Washingtonto campaign in their districts, meet with constituents, visit businesses, and hold town hall meetings. Be sure you are part of this activity! Occupational therapy has a number of important issues before Congress, and these recess periods can be extremely effective in promoting occupational therapy issues. You can contact your Senators' and Representative's offices to get their recess event schedule. Contact the Federal Affairs office with any questions at fad@aota.org.
Budget
On April 28, Congress approved the conference agreement on the FY 2006 budget resolution (H.Con.Res. 95). The House passed the conference report by a 214-211 vote while the Senate approved it 52-47. Despite efforts by Senators Gordon Smith (R-OR) and Jeff Bingamen (D-NM) and Representative Heather Wilson (R-NM) to remove them, provisions included that require the Senate Finance Committee and the House Energy and Commerce Committee to reduce spending by about $10 billion over 5 years. The most likely result will have the money come from Medicaid. The budget resolution includes a September 16 deadline for committees to submit their plans for cutting mandatory spending programs such as Medicaid and Medicare.
Medicaid Commission
Also included in the budget resolution is an amendment by Senator Smith requiring the formation of a Medicaid commission that will be charged with recommending Medicaid cuts to the Congressional committees. The commission was intended to be run by the Institute of Medicine, but is now being organized by Health and Human Services (HHS) Secretary Michael Leavitt. The commission will "advise the Secretary on ways to modernize the Medicaid program so that it can provide high-quality health care to its beneficiaries in a financially sustainable way." The first report is due by September 1, 2005, and is intended to help guide the Senate Finance Committee and House Energy and Commerce Committee in identifying the above-referenced cuts required in the FY 2006 budget resolution. The commission will include voting members (max of 15), nonvoting advisor members (max of 15), and nonvoting congressional advisor members (max of 8). The voting members may include governors; policy experts; state Medicaid directors; federal Medicaid administrators; the HHS Secretary; other members specified by the HHS Secretary; "individuals with expertise in health, finance, or administration; and Ex Officio Members." The nonvoting advisor members can include state/local government officials, providers, and consumers. Continue to watch the Legislative Action Center for further developments.
Secretary Leavitt will appoint 15 nonvoting members, with invitations to Democrats and Republicans on Capitol Hill to appoint 4 nonvoting members each. House and Senate Democrats have decided not to appoint members to the Medicaid commission, citing advisory roles without a vote as being inadequate.
IDEA Public Meetings Set
The U.S. Department of Education has announced the locations for their public input sessions on the proposed regulations for the amended Individuals With Disabilities Education Act (IDEA). The public meetings are scheduled for June and early July, and will occur during the public comment period for the proposed rules that are expected to be published in the Federal Register in early June.
No Child Left Behind Act
As a follow-up to her announcement to chief state school officers last month, U.S. Secretary of Education Margaret Spellings announced on May 10th the details of a new No Child Left Behind (NCLB) policy designed to help states better assist students with disabilities, and pledged to continue working with states to ensure they have the flexibility needed to raise student achievement. (See last month's Legislative Update for a related announcement from the Secretary).
The new guidelines reflect research that shows that approximately 2% of all students can make progress toward grade-level standards when they receive high-quality instruction and are assessed with alternate assessments based on modified achievement standards. The new guidelines outline the process for how eligible states can implement this new policy in the short term until the Department of Education (DOE) issues final regulations on the policy.
AOTA and other advocates are concerned that this policy is actually a retreat from the DOE's previous stance on holding schools accountable for all students, and is in response to the growing chorus against NCLB in general and the inclusion of students with disabilities in particular. It is still not clear who this 2% group of students is, how they will be identified, what modified achievement standards are, and what the implications of this policy on school accountability for what and how they teach students with disabilities will be. It also remains unclear how this new policy will interface with the new IDEA and pending regulations. What is clear, however, is that occupational therapy has a role to play in helping schools and IEP teams identify appropriate accommodations for students and determining when a given student should receive an alternate assessment. AOTA will work with the DOE to better articulate this role and to identify opportunities for occupational therapists and occupational therapy assistants as the new policy is implemented. Watch the IDEA Information Center for more information.
For more information on the new NCLB policy, see the Department of Education press release.
Special Education Research
In other Department of Education news, Edward Kame'enui, an international authority on learning problems and special education, has been named the nation's first Commissioner for Special Education Research. He will lead a newly established office within the Institute of Education Sciences (IES), the research arm of the DOE. A native of Hawaii, Kame'enui started his special education career in 1971 as a teacher and houseparent at a residential treatment center in Wisconsin for children with serious emotional and behavior problems. He joins IES from the University of Oregon, where he has been a faculty member for the past 17 years. Read the press release for more information.
In addition, the DOE published the availability of grants to support education research for FY 2006 (in the Federal Register). The intent of these grants is to provide national leadership in expanding fundamental knowledge and understanding of education from early childhood education through postsecondary and adult education. The newly established National Center for Special Education Research will support research in special education on the following topics: Reading and Writing, Science and Mathematics, Early Intervention and Assessment for Young Children with Disabilities, Language and Vocabulary Development, Serious Behavior Disorders, Assessment for Accountability, Individualized Education Programs (IEPs), and Secondary and Postsecondary Outcomes.
Occupational therapy researchers and scientists are encouraged to apply for these grants. Information regarding program and application requirements, including selection criteria and review procedures, for each of the Institute's competitions is contained in the applicable Request for Applications package, which will be available at the following Web site: http://www.ed.gov/about/offices/list/ies/programs.html. To read the Federal Register notice, go to http://www.ed.gov/legislation/FedRegister/announcements/2005-2/050605a.pdf.
GAO Publishes Rehabilitation "75 Percent" Report
On April 22, the Government Accountability Office issued a report on the "75 percent rule" for inpatient rehabilitation facilities as required in the Medicare Modernization Act. Under the 75 percent rule, in order to be qualified as an IRF and receive higher Medicare payments based on the rehabilitation prospective payment system, at least 75 percent of a facility's patients must require intensive rehabilitation treatment for one of 13 specified conditions. The report recommends that the Centers for Medicare and Medicaid Services (CMS) Administrator take three actions:
- Ensure that fiscal intermediaries conduct targeted reviews for medical necessity for IRF admissions
- Conduct additional activities to encourage research on the effectiveness of intensive rehabilitation and the factors that predict patient need for intensive inpatient rehabilitation
- Refine the conditions list to define more precisely those subgroups of patients in need of IRF services, possibly using functional status or other factors.
AOTA will continue to follow the 75 percent rule and work closely with CMS. Stay tuned to the Legislative Action Center for new developments.
Grassroots Call to Action on Therapy Caps
AOTA staff has recently made a hard push to encourage AOTA members to contact their Senators and Representatives for support of the Medicare Access to Rehabilitation Services Act of 2005 (S. 438/H.R. 916). The legislation would repeal the $1,500 annual cap on Medicare Part B outpatient therapy for occupational therapy alone and physical therapy and speech-language pathology combined. A 2-year moratorium was included in the Medicare Modernization Act of 2003 (P.L 108-173); however, that moratorium will expire on December 31, 2005. AOTA needs all members to contact their representatives and urge their support by cosponsoring this legislation. Currently, AOTA and other coalition members are targeting Senate and House Republicans for their support. Use the Legislative Action Center to contact your Member of Congress and to keep up to date.
Medicare Physician Payment Legislation Introduced
Senators Jon Kyl (R-AR) and Debbie Stabenow (D-MI) and Representatives Clay Shaw (R-FL) and Ben Cardin (D-MD) have introduced the Preserving Patient Access to Physicians Act of 2005 (S. 1081/H.R. 2356), legislation aimed to avert projected reductions in Medicare physician payments. The bill provides physicians with a minimum update in 2006 and 2007. Specifically, the legislation overrides the Sustainable Growth Rate formula in these years; the update to the single conversion factor in 2006 would be 2.7%, and a formula based on input prices and a productivity adjustment is used for 2007 - the likely update for 2007 will be 2.6%.
AOTA Submits Testimony to House Energy and Commerce Subcommittee on Health
AOTA staff submitted testimony to the House Energy and Commerce Subcommittee on Health's hearing, Long-Term Care and Medicaid: Spiraling Costs and the Need for Reform. Currently, long-term care in the Medicaid program is expensive, inadequate, disorganized, and contains a bias toward institutional services over home and community based care. Every state that receives Medicaid funding must provide nursing home services, but community-based services are optional. AOTA's testimony supports options for long-term care in Medicaid and ultimately supports the elderly and persons with disabilities who want to be free from institutional life and welcomed into society as valued, responsible, and productive citizens.
Friend of OT
Representative Patrick Kennedy (D-RI) submitted a statement recognizing Occupational Therapy Month for the May 5th Congressional Record. Go to http://thomas.loc.gov/cgi-bin/query/D?r109:1:./temp/~r109mDi7lW:: to read Representative Kennedy's statement.
AOTPAC
The AOTPAC Board of Directors conducted their annual meeting on May 11, 2005 in conjunction with the AOTA Annual Conference in Long Beach, CA. They developed plans for 2005 fundraising, set a goal to raise $250,000 by the end of 2005, discussed candidate support for the 2006 elections, and discussed efforts to promote AOTPAC in the future to state associations and OT/OTA schools. During the Conference, AOTPAC hosted a booth where Board members and staff talked with AOTA members about political and legislative activity and raised funds. AOTPAC also hosted a fundraising event on Saturday evening. Contributions of over $18,000 were raised through Conference activities, exceeding all previous Conference receipts. Thanks to all AOTA members who made this happen.
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, MD 20824-1220, Telephone: 800-729-2682, or Fax: 301-652-7711.
06/21/05