Federal Legislative Issues Update - Nov 2005
November 2005
Washington Update
As it currently stands, there is only 1 week left on the congressional schedule after Thanksgiving. However, if legislators do not complete a core list of issues prior to the end of the first week of December, that timeline could be extended. Of most importance to AOTA on the legislative calendar is the completion of the FY2006 Budget Reconciliation bill and the remaining appropriations bills, particularly the Labor-HHS-Education appropriations bill.
FY2006 Budget Reconciliation - Possible Changes to Medicare and Medicaid
Budget reconciliation is defined as legislation making changes to existing law (such as entitlements under Medicare or Medicaid) so that it conforms to numbers in the budget resolution. In February of 2006, President Bush laid out a plan to cut the national budget deficit in half by 2009. The House and Senate closely followed suit in passing a FY2006 budget resolution that called for instructions to find targeted savings in various House and Senate committees. These reconciliation instructions from the House and Senate have been the highest priority for House and Senate leaders this fall. The following information details possible changes to the Medicare and Medicaid programs as Congress continues to debate a final FY2006 Budget Reconciliation bill.
Medicare
Therapy Caps
As previously reported on the AOTA homepage, AOTA was successful in its advocacy by achieving a 1-year moratorium in the Senate Finance Committee's budget reconciliation package which just passed a full Senate vote on November 3. The House Ways and Means Committee did not include any Medicare changes in their budget reconciliation package due in large part to politics, therefore leaving out anything that could address the therapy caps in their version.
Once the House passes their version of the reconciliation bill, a conference committee will be formed from Members of the House and Senate to iron out the differences in the two budget reconciliation packages. During conference, the conferees could include the Senate language of a 1- year moratorium or something different. AOTA staff is continuing to lobby key members and staff to assure that a moratorium or repeal is included.
The House is expected to bring their version to the House floor the week of November 14. House leaders lost a chance on November 10 to pass the $50 billion-plus reconciliation bill due to a lack of votes. Congressional leaders will likely look to tweak the package this week in order to garner the necessary support for final passage.
Watch the Legislative Action Center for more details and CONTACT YOUR REPRESENTATIVES. Go to http://capwiz.com/aota/mail/oneclick_compose/?alertid=8176686 to send an electronic form letter or to find your elected representatives contact information. AOTA continues to work for support of the Medicare Access to Rehabilitation Services Act of 2005 (H.R. 916/S. 438) which would repeal the therapy caps. Contact the Federal Affairs Department if you have any questions at 1-800-SAY-AOTA or fad@aota.org.
75% Rule
The Senate Finance Committee included a 2-year extension of the 50% compliance threshold used to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility (IRF) in their package that passed the full Senate on November 3. Also included was language directing the Inspector General to conduct a study that analyzes the types of patients treated at IRFs that have a compliance rate between 50% and 60% and report to Congress and the Secretary of Health and Human Services by January 1, 2007, with its findings. A rehabilitation advisory council would be established by the Secretary to provide advice and recommendations concerning the coverage of rehabilitation services under the Medicare program.
Unfortunately, as previously mentioned, the House of Representatives did not include any Medicare language in their reconciliation bill. Therefore, now is a critical time to contact your elected representatives to encourage their support and inclusion of the Senate language in a final FY2006 Budget Reconciliation bill. Use the Legislative Action Center to contact your members of Congress to voice your support at http://capwiz.com/aota/mail/oneclick_compose/?alertid=7929781.
Physician Fee Schedule
Also included in the Senate reconciliation bill is a 1-year update to the physician fee schedule that provides Medicare payments for services of physicians and certain non-physicians, including occupational therapists. The physician fee schedule is updated according to a complex formula that takes into account several factors including a target for Medicare spending over time (i.e. Sustainable Growth Rate), inflation, and others. The fee schedule is slated for a 4.4% cut to 2005 payments if Congress does not take action by December 31, 2005. The Senate reconciliation bill included a 1% increase to the 2005 fee schedule levels in their bill. However, as noted, the House of Representatives has included no Medicare language in their bill.
AOTA has worked in coalition with a number of other provider associations to encourage Congress to adopt at least the Senate levels for a 1-year update. Continue to watch the Legislative Action Center for more details.
Pay for Performance
Pay for performance is a proposed change in the way Medicare reimburses doctors and others, including occupational therapists, for the care they provide services. Facility services may also be affected. Pay for performance is intended to provide an incentive for physicians and practitioners to use evidence-based practice, improve efficiency, and achieve better patient outcomes.
Pay for performance (P4P) has taken the fast track in Washington over the past few months. Congress introduced bills in the House and Senate in June and July, and now plans to include a first step in the direction of P4P in the budget reconciliation bill. The Senate reconciliation bill would require the Secretary of Health and Human Services to develop provider-specific quality measurement systems for making value-based payment to hospitals, physicians, and practitioners (including occupational therapists), Medicare Advantage plans, end stage renal disease providers and facilities, and home health agencies.
In addition to establishing a program under which value-based payments are provided each year to physicians and practitioners that demonstrate the provision of high-quality health care to individuals enrolled under Part B, MedPAC would be required to conduct a number of studies. One of the studies would look at how the Medicare value-based purchasing programs will affect Medicare beneficiaries, Medicare providers, and other areas of the delivery system. Another study would report on the advisability and feasibility of establishing a value-based purchasing program for skilled nursing facilities.
Since the House is not including Medicare language, P4P has not been included in their discussions. However, P4P language can be adopted by the conference committee when the House passes their reconciliation bill.
AOTA staff has participated in a number of meetings with physician and non-physician groups to discuss the implications of the Senate language on P4P. Also, as reported in the September Legislative Issues Update, the Centers for Medicare and Medicaid (CMS) plan to introduce a demonstration project for a P4P initiative in early 2006.
The Essential Care Coalition, of which AOTA is a strong member, has expressed concern to CMS officials and to members of Congress on the role of non-physicians in a P4P system. AOTA will continue to work to ensure that any new system put forth will address the unique circumstances faced by many therapy beneficiaries. Continue to watch the Legislative Action Center for further developments or contact the Federal Affairs Department with any questions at 1-800-SAY-AOTA or fad@aota.org.
Medicaid
The reconciliation debate has impacted many aspects of policy important to AOTA, but none more so than the Medicaid program. The Senate passed a reconciliation bill that limited cuts to Medicaid and made most cuts in the amount the program pays to drug companies for prescription drugs. In the House, however, Medicaid received significant attention when legislators were making cuts, and many of the provisions would negatively impact beneficiaries. The House leadership has been unable to gain the votes they need to pass the bill that, as written, would cut over $50 billion, with more than $10 billion cut from Medicaid alone. The Senate bill had $35 billion in total cuts with less than $5 billion cut from Medicaid. Many moderate Republicans are concerned about the magnitude of the spending cuts in the bill and are standing firm against such drastic cuts in Medicaid. One of the most common concerns relate to changes to asset transfer rules and increases in cost sharing for beneficiaries. Although AOTA is very concerned about those issues, we are also lobbying hard against proposed changes to the definition of targeted case management that would negatively impact access to quality care for people with mental illness and developmental disabilities in particular. AOTA is also concerned about shifting some children from Medicaid to State Child Health Insurance Programs (SCHIP). This would be a problem because it eliminates the federal requirement included in Medicaid, but not in SCHIP, to provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services.
AOTA continues to lobby Congress in opposition to any changes that will negatively impact Medicaid beneficiaries. See the Legislative Action Center at: http://capwiz.com/aota/home/ for more information and new Action Alerts as the budget reconciliation debate continues.
Money Follows the Person
The Senate reconciliation bill included funding for a Money Follows the Person demonstration project to award grant money to states to adopt the initiative. The bill authorizes the Secretary of Health and Human Services to provide grants to states to conduct demonstration projects that are designed to enable Medicaid-eligible individuals to receive support for appropriate and necessary long-term services in the settings of their choice. The goal of rebalancing the Medicaid dollars is to increase the use of home and community-based settings which are preferred by Medicaid beneficiaries instead of institutional, long-term care facilities. Contact your elected member of the House of Representatives to encourage the inclusion of Money Follows the Person in the House reconciliation bill.
Title VII Funds Threatened in House-Senate Conference
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 this week. Recent reports suggest that the conferees will begin discussions on Labor-HHS-Education appropriations bill based on the House of Representatives version. 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 percent) increase over FY 2005.
Go to the Legislative Action Center at http://capwiz.com/aota/mail/oneclick_compose/?alertid=7799076 to contact the conferees of the Labor-HHS-Education bill and ask them to support the Senate funding levels in the conference bill.
The Health Professionals and Nursing Education Coalition (HPNEC), of which AOTA is a strong member, has worked in the last few weeks to garner support from members of Congress to protect Title VII funds. We need your help to encourage the conferees to sustain the FY2005 levels for Title VII funding.
IDEA Regulations
The Department of Education recently announced a delay in the release of the final Part B regulations for the recently amended Individuals with Disabilities Education Act (IDEA, P.L. 108-446). The Department had hoped to publish the regulations in the Federal Register before the end of the year, but it now appears this will occur in early 2006. Proposed rules for the Part C early intervention program will not be published until after the Part B rules are finalized. AOTA submitted comments on the proposed regulations in September. Watch the AOTA Web site and OT Practice for more information on the regulations.
More IDEA News
This year marks the 30th anniversary of the enactment of IDEA's predecessor, the Education for All Handicapped Children Act (P.L. 94-142). In recognition of this milestone, Representatives Michael Castle (R-DE) and Lynn Woolsey (D-CA) introduced a bipartisan concurrent resolution (H.Con.Res. 288) on November 2. The House and Senate are expected to approve the measure. The Department of Education is planning an event for November 15. Look for a report in next month's Update.
AOTA Meets With Commissioner of Special Education Research
Federal Affairs staff recently met with Dr. Edward Kame'enui, the commissioner of the National Center for Special Education Research at the Department of Education, to discuss plans for research on related services as required under the 2004 amendments to IDEA. Dr. Kame'enui expressed interest in recommendations and suggestions on how to appropriately address related services in future proposals. AOTA provided copies of AOTA's August 16th comments on the proposed research priorities of the Institute of Education Sciences (IES), the Education Department's research arm. were provided. Overall, staff recommended research projects that would confirm what we know, investigate what we do not know, and add to the knowledge base regarding the relationship of related services to child outcomes and student results. AOTA will continue to work with the commissioner to ensure the inclusion of occupational therapy.
Supreme Court Issues Ruling in Special Education Case
In early October, the Supreme Court heard arguments from a local Maryland school district (Montgomery County, Maryland) on whether the parent or the district has the burden of proof when a parent disagrees with the special education program offered by the district. The court ruled on November 14, 2005 that the party seeking relief, whether it is the student and/or family or the school district, has the burden of proof. Justice O'Connor delivered the opinion of the Court with Justices Stevens, Scalia, Kennedy, Souter and Thomas concurring. Justices Ginsburg and Breyer filed dissenting opinions. Chief Justice Roberts had recused himself from participating in the decision because of his previous work with one of the attorneys in the case. To view the Supreme Court decision, go to the Supreme Court Web site.
Students with Disabilities and No Child Left Behind
AOTA Federal Affairs staff, in a leadership role with the Education Task Force of the Consortium for Citizens with Disabilities (CCD), met with Department of Education officials to discuss concerns on several issues regarding students with disabilities. These concerns include assistance for states to meet the needs of students with disabilities displaced by Hurricanes Katrina and Rita; new policies under the No Child Left Behind Act (NCLB); and the lack of parent and special education representation on Department advisory groups. CCD had previously raised concerns about these issues on a number of occasions but did not succeed in securing a meeting until now. To read more about CCD, go to: http://www.c-c-d.org/tf-education.htm.
AOTA Supports Efforts to Keep People With Disabilities in the Community
AOTA staff recently attended a Congressional briefing announcing the introduction of the Community Living Assistance Services and Supports Act of 2005 (S. 1951) also known as the CLASS Act. The bill will provide services and supports within the community to help people with severe functional impairments to remain as independent as possible while providing them with choices related to community participation, education, and employment. The bipartisan bill was sponsored by Senators Kennedy (D,-M) and DeWine (R-OH). AOTA has written a letter of support to the sponsors and has included the bill in the Legislative Action Center as AOTA-supported legislation. . More information can be found at http://capwiz.com/aota/issues/bills/?bill=8241771
Rehabilitation Research Initiatives
AOTA is participating in legislative and federal agency advocacy efforts to increase funding, visibility and support for research on rehabilitation at the federal level. Much of the work is targeted toward raising the profile of the National Center for Medical Rehabilitation and Research (NCMRR), which is housed under the National Institute for Child Health, Human Development Research (NICHD), part of the National Institutes of Health (NIH).
AOTA is also participating in the development of a broader coalition seeking to promote all aspects of rehabilitation research. This effort would include the National Institute for Disability and Rehabilitation Research (NIDRR) under the Department of Education as well as NIH and private foundation-sponsored research.
AOTA staff are working in coalition with other groups including professionals and consumers and consulting with occupational therapists around the country who are researchers funded by the programs targeted in this effort. The goal of AOTA in relation to promoting rehabilitation research is both long- and short-term. Initially we intend to influence legislation that will reauthorize the NIH, and in the longer term, and develop an ongoing coalition to support rehabilitation research.
Mental Health Parity Legislation Update
AOTA remains active in support of the Paul Wellstone Mental Health Equitable Treatment Act of 2005 (H.R. 1402). Other events, such as reconciliation, have left little room on the Congressional legislative calendar for parity debate, but interest groups in support of mental health parity continue to build support for the legislation.
The majority of House and Senate members support this bill; the challenge is to build enough momentum and attention to force the Congressional leadership to bring the bill to the floor for a vote. AOTA will continue to advocate in support of this important legislation and work with other consumer and professional organizations to push for a vote on this during 2006.
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.
11/15/05