Federal Legislative Issues Update - Oct 2005
October 2005
Budget Tops Growing List of Legislative Priorities
Budget reconciliation, a legislative process that makes changes to existing laws (such as entitlements under Medicaid or Medicare) to meet targeted numbers in the budget resolution, has become the number one priority for Congress. Adjournment will likely get pushed into December, so there is still limited time for Congress to complete a number of legislative priorities. While the reconciliation process tops the list of "to dos, " other items on the agenda include hearings and confirmation of Supreme Court nominee Samuel Alito, appropriations bills, and more Hurricane Katrina/Rita relief.
Of specific concern to AOTA in the reconciliation process are directions for the Senate Finance Committee, House Ways and Means Committee, and House Energy and Commerce Committee to find savings—or make cuts—to the Medicare and Medicaid programs. While the House committees continue to push forward with their legislation, the Senate Finance committee has been stalled by a lack of votes from Republican Senators that would clear the reconciliation bill out of committee and bring it to the floor for a final vote.
AOTA staff has diligently worked to address a number of issues with Congressional members, their staff, and relevant committee staff during this process, including a solution to the therapy caps. Stay tuned to the Legislative Action Center for more information and find out how to take action now.
AOTA President Baum Meets With Congressional Leaders
AOTA President M. Carolyn Baum took the message of occupational therapy to Capitol Hill when she visited Washington, DC on October 18 to meet with key congressional leaders. President Baum focused on the Medicare Part B cap and its effect on the full range of occupational therapy services.
"Representing the profession on policy issues is an exciting and stimulating experience," she said. "Our message is one that resonates with leaders who are struggling to achieve efficient solutions to our health and social problems." President Baum's agenda included meetings with Representatives Ben Cardin (D-MD) and Phil English (R-PA) and their staffs, who have championed therapy cap repeal legislation.
The most significant meeting of the day occurred with Nancy Johnson (R-CT), chairman of the U. S. House of Representatives' Ways and Means Subcommittee on Health. Johnson had sought the meeting as debates about Medicare were heating up. Chairman Johnson eagerly listened to the many ways occupational therapy services, funded under Part B, help to keep older people more independent and living in the community. Johnson asked about research and interventions that focus on home safety, vision impairments, dementia, and other areas.
President Baum promoted a solution to the cap that would extend maximum Part B benefits to patients while a process is underway to strengthen review mechanisms and ensure appropriate utilization and the achievement of specified outcomes. Johnson's interests in health care include the use of the least costly and most appropriate setting for services as well as case management to ensure coordination and best practices.
After the meeting, President Baum noted that policymakers who hear about occupational therapy often get excited when they realize that occupational therapy is part of the solution when it comes to lowering costs and achieving outcomes.
"Every OT and OTA can carry this message. Advocacy can push policies that support the full range of occupational therapy's value. We should and we must speak out." Baum was very pleased with the reception by Chairman Johnson. The Subcommittee on Health has responsibility for all legislation relating to Medicare; any repeal or other solution must be approved by the Subcommittee before going to the House floor.
Congress Must Hear From You as Therapy Caps Near
With only a limited number of weeks left before Congress adjourns later this year, therapy providers and beneficiaries are getting closer to seeing the possible therapy cap implementation on January 1, 2006. If Congress does not take action to address the therapy caps before December 31, 2005, there will be an approximate $1,740 cap on Part B payments for outpatient occupational therapy. AOTA encourages all occupational therapists, occupational therapy assistants, and students of occupational therapy to contact their Representative and two Senators and encourage their support for repeal by cosponsoring the Medicare Access to Rehabilitation Services Act of 2005 (S. 438/H.R. 916). Use the Legislative Action Center to contact Capitol Hill and ask for their support.
AOTA will continue to work with the TriAlliance (AOTA, the American Physical Therapy Association [APTA], and American Speech-Language-Hearing Association [ASHA]) and other provider groups affected by the therapy caps to find an appropriate solution to the problem. AOTA Federal Affairs staff has continued to meet with members of Congress, their staff, and the relevant committee staff to find a proper solution. While there are only a few of us, there are thousands of YOU in every state, so we need your help now more than ever. If your elected representatives are already cosponsors, then remind them of the end of the year deadline and the need to have this very important issue addressed this fall. If they are not a cosponsor, encourage them to become one now.
The TriAlliance and many other provider groups have implemented an advertisement campaign in Roll Call and The Hill, both congressional news publications used by members of Congress and their staff, in order to spotlight the need for Congressional action to the therapy caps this fall. Contact AOTA's Federal Affairs Department at 1-800-SAY-AOTA to get a copy of the advertisement.
If you have any questions or need assistance in contacting your member of Congress, contact AOTA's Federal Affairs Department at 1-800-SAY-AOTA or fad@aota.org.
Medicaid
Medicaid reform has been delayed for over a month now, but the Senate seems ready to take up the issue in late October as part of budget reconciliation. Concerns over the extent of the cuts continue to grow because of the need to pay for the costs of Katrina relief. Originally, Medicaid cuts were expected to be around $10 billion dollars, but now the amount of cuts could increase by several billion dollars. AOTA has worked hard in coalition with other consumer and provider groups to eliminate changes to rehabilitation and targeted case management reimbursement from both House and Senate plans. While we have been successful so far, the chance of their inclusion in the final bill remains possible, especially as the call for even deeper cuts grows among fiscal conservatives. See the new Medicaid action alert posted on the Legislative Action Center at: http://capwiz.com/aota/mail/oneclick_compose/?alertid=8117546
Be sure to check the AOTA Web site for more information and updates on this important issue impacting occupational therapy professionals and the 53 million Americans on Medicaid.
Congressional Relief for Hurricane Katrina
While Congress has already passed $63 billion in dedicated Katrina Relief, the most significant and controversial piece of relief legislation proposed by Senators Grassley (R-IA) and Baucus (D-MT) has been held up in the Senate. The bill, S. 1716, the Emergency Health Care Relief Act is pitting the Senate Finance Chairmen, Grassley and Ranking member Baucus against Senate Majority Leader Bill Frist in regard to moving this legislation. While Senator Frist will not bring the bill to the floor for a vote, Senator Grassley has threatened to hold up other legislation until he gets a vote, or to roll the Katrina relief package into the reconciliation process which he controls in the Finance Committee.
The Emergency Health Care Relief Act would assist the three states most affected by the Hurricane with 100% Federal Matching funds (FMAP), and create expanded eligibility for low income individuals displaced by the hurricane who would not normally be an eligible population for Medicaid. It also would assist states who have taken in displaced victims of hurricane Katrina by providing 100% FMAP for those individuals.
AOTA supports the Grassley/Baucus legislation but is concerned that including it in the reconciliation bill would require the Senate Finance Committee to cut other aspects of Medicaid even further in order to pay for it. The timeline for a decision on this issue remains up in the air but could come as soon as the last 2 weeks in October. Because this issue is very much related to Medicaid reform, see updates in the Legislative Action Center on Medicaid for more information.
Occupational Therapy Practitioners and Students Visit AOTA and Capitol Hill to Advocate for the Profession
Occupational therapy practitioners and students descended on Capitol Hill (when?) to ensure that Congress heard the voice of occupational therapists on the issues important to their practice and their patients. Groups have come every few weeks since September from New York, Florida, California, Pennsylvania, West Virginia, and other states to convey their message. Here is a glimpse of what has happened so far:
Students from West Virginia University and Shenandoah University came to AOTA (what day or month?), received a legislative briefing from the Federal Affairs Department and went to Capitol Hill to advocate on issues including cap repeal, the 75% rule, Medicaid reform, home health qualifying service, education issues, expanding research, and mental health.
These groups followed up on AOTA's Fly-In day at the end of September to ensure that those efforts were heard loud and clear. AOTA set September 27 as the Kick-Off Day to come to Washington and advocate for occupational therapy. Nearly 30 congressional meetings were conducted by the group, allowing the occupational therapy voice to be heard.
Also, a delegation from New York and New Jersey, organized by NYOTA Legislative Chair Jeff Tomlinson, had nearly 30 productive meetings with their representatives.
In total, almost 90 occupational therapists, occupational therapy assistants, and students of occupational therapy from all around the country made the trip to Washington and met with their members of Congress over the last month.
You can still help by visiting the Legislative Action Center and contacting your legislators. Seek opportunities to meet with your representatives at home. If you are planning a trip to Washington and want to get more involved with advocacy, contact the Federal Affairs Department at fad@aota.org. Groups are invited to come throughout the fall to meet with their elected representatives in Congress. Contact AOTA Federal Affairs staff for assistance in planning your trip.
AOTA Call for Member Comments on Power Mobility Devices
The Centers for Medicare & Medicaid Services (CMS) published a draft interim final rule governing power wheelchairs and power-operated vehicles in the August 26 Federal Register. On September 14, the Medicare Durable Medical Equipment Regional Carriers (DMERCs) issued a draft local coverage determination (LCD) governing power mobility devices that is based on CMS' interim final rule and that limits the role of occupational therapists in evaluating beneficiaries for power mobility devices.
The draft LCD proposes several provisions that will affect occupational therapists. AOTA strongly urges members to take action. Go to the Legislation Action Center at http://capwiz.com/aota/issues/alert/?alertid=8140051&type=CU to read more, become involved, and submit comments.
Title VII Funding Update
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-Ed Appropriations Conference Committee—a committee of House and Senate leaders—will reconcile the House and Senate versions of the bill this fall. Since budget issues have taken a front row seat in discussions, it is extremely important that AOTA members work to protect these funds in the conference committee negotiations. See the Legislative Action Center for more details.
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. As part of the efforts, AOTA and HPNEC are working with Representative Charlie Norwood (R-GA) and Diana DeGette (D-CO) to circulate a sign-on letter to be sent to the conference committee members. Also, the coalition sponsored a lunch briefing on October 14 for congressional staff to learn more about the importance and benefits of Title VII and VIII funding.
AOTA Supports Tighter Guidelines for Therapeutic Boarding Schools
AOTA has become involved in efforts to improve safety and quality efforts for residential treatment facilities. Under current law and regulations, there is little oversight for "therapeutic boarding schools." A new bill introduced by Representative George Miller (D-CA), the End Institutional Abuse Against Children Act of 2005 (H.R. 1738), would require states to create rules and licensing mechanisms to govern institutions established for the purpose of education and behavior modification of at-risk youth. AOTA is supporting the legislation in conjunction with the Mental Health Liaison Group, a coalition of consumers, providers, and mental health advocates. While some schools and treatment programs that would fall under the jurisdiction of the new law are already high quality institutions, there is currently no way to ensure that the safety and rights of children are being protected in the vast majority of these boarding schools. Federal Affairs staff recently attended a congressional briefing regarding the bill sponsored by the ASTART coalition (Alliance for Safe, Therapeutic and Appropriate use of Residential Treatment). During the briefing, psychologists spoke about the lack of evidence-based treatment at these facilities; a former worker discussed abuse that she had seen at a facility in Idaho; and a former "student" related the emotional and physical abuse she suffered in the name of treatment.
Another piece of legislation that was mentioned at the briefing by Congressman Pete Stark (D-CA) was the Keeping Families Together Act of 2005 (H.R.823/S.380), which would provide financial incentives for states to treat children with mental and behavioral issues in the home rather than removing them from parental custody in order to organize and fund the treatment. In too many states all over the country, children are being removed from their parents' custody because treatment costs are too high for the family to afford, and there is no other mechanism for payment unless the child is in the custody of the state. If passed, the Keeping Families Together Act would help states to meet the needs of these children and families without having to file for custody of the child.
For more information on both of these issues see the Issues and Legislation section of the Legislative Action Center on AOTA's Web site.
AOTA Joins the 1% Coalition to Support People with Severe Disabilities
On October 6, 2005, Senators Pat Roberts (R-KS) and Ted Kennedy (D-MA) and former Senator and 1% Coalition co-chair Bob Dole (R-KS) introduced the Employer Work Incentives Act for Individuals with Severe Disabilities (S.1570). This bill provides incentives for federal contractors and subcontractors who employ and help insure people with severe disabilities. The 1% Coalition is a group of consumer, provider, business, and advocacy organizations that support efforts to improve opportunities for employment for people with severe disabilities. The name 1% Coalition stems from the fact that 9.4 million Americans are considered severely disabled and moving 1% of those, only 94,000 people, from Social Security Disability Insurance or Supplemental Security Income into the workforce would save the government billions of dollars every year and improve the quality of life for people with disabilities. AOTA and occupational therapy are committed to helping people with disabilities to maximize function and independence to succeed in all aspects of life, including employment. The 1% coalition Web site is currently under construction but will soon be available at: www.onepercentcoalition.org
Mental Health Parity Legislation Update
AOTA remains active in support of the Paul Wellstone Mental Health Equitable Treatment Act of 2005 (H.R. 1402). We do this through direct lobbying, correspondence, and participation with the Mental Health Liaison Group which brings together, consumer, provider, and advocacy organizations to address legislation impacting mental health at the federal level. There are currently 207 cosponsors of this legislation in the House and the bill is yet to be introduced in the Senate, although significant work is being done behind the scenes and introduction could happen at any time. Parity legislation would require private health insurance providers to provide the same coverage for mental health services as they do for physical medicine services. While the House bill is very similar to the bill introduced in the 108th Congress, the current bill has extended parity to coverage of substance abuse services as well. Check the Legislative Action Center for updates and Action Alerts on this issue.
American Occupational Therapy Political Action Committee News
Board members are participating in state association conferences around the country. In October, they attended or will participate in the following state conferences: Nebraska, Wisconsin, and Massachusetts. In November, representatives will be at meetings in Maryland, Tennessee and New Mexico.
The American Occupational Therapy Political Action Committee (AOTPAC) continues to solicit for contributions to meets its goal of $200,000 for calendar year 2005. However, $50,000 is still needed and we encourage all AOTA members to provide support in any amount that they can. Recently an e-mail was sent regarding the 87 days left until the Medicare cap returns and we have had some good success from that, but more still needs to be done. See the many legislative issues AOTA is working on by visiting the Legislative Action Center on the Web site (www.aota.org). Send contributions to support the political and legislative purposes of AOTPAC to: AOTPAC, PO Box 31220, Bethesda, MD 20824-1220. Contact Darlene Dennis at 1-800-SAY-AOTA or by email at aotpac@aota.org. Checks payable to AOTPAC and credit card information (Mastercard, Visa and Discover only) can be accepted. Contributions are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary and refusal to contribute does not affect a member's rights.
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.
11/08/05