Federal Legislative Issues Update - Sept 2005
September 2005
Washington News
In the wake of Hurricane Katrina and now two openings on the Supreme Court, the legislative agenda and schedule for Congress this fall remains to be established. Both the Senate and House have formally postponed until the end of October the deadlines for their respective Budget committees to report legislation to cut mandatory spending, specifically $10 billion from Medicaid (read more below), as directed by the FY 2006 budget resolution reconciliation instructions. Additionally, the House and Senate have recently passed a $10.5 billion supplemental for Katrina emergency relief. Additional hearings and emergency relief can be anticipated before Congress adjourns later this year.
Complicating matters further, the end of FY 2005 is approaching at the end of September, and a continuing resolution will be necessary to fund the operation of the government for the 10 remaining appropriations bills not yet signed into law. Included with these bills is the Title VII appropriation in the Labor-HHS-Education appropriations bill (read more below) that includes funds for allied health.
Also, as proclaimed by President George H.W. Bush in 1991, the 3rd week in September is National Rehabilitation Week. The American Occupational Therapy Association (AOTA) urges its members to contact their Representatives during the week of September 19-23 to stress the importance of resolving therapy cap legislation, the 75% rule, as well as other important issues to the occupational therapy profession. Go to AOTA's Legislative Action Center to read more.
Medicaid
Before Hurricane Katrina, Congress had decided to make $10 billion in cuts to the Medicaid program. The reconciliation process, which would determine exactly where the cuts were to be made, however, has been delayed at least until after the Columbus Day weekend because Congress is focused on Katrina relief efforts. From a legislative perspective, the delay is an opportunity to build support for Medicaid, which is now the nation's largest health care program providing coverage for over 53 million Americans. Although some of the proposals for Medicaid reform make good policy sense, such as reducing the cost the government pays for prescription drugs under Medicaid, other provisions are problematic. AOTA opposes any provision that reduces access of care for Medicaid beneficiaries. Most specifically, the Bush Administration has proposed changes to the definition of rehabilitation services under Medicaid that would significantly restrict reimbursement and access to occupational therapy as well as other skilled therapies and mental health services. See the Legislative Action Center, , for more information and updates on this important issue.
Hurricane Katrina and Students With Disabilities
Federal, state, and local governments are working to ensure that the education needs of the estimated 300,000-400,000 children displaced by Hurricane Katrina, including those who need special education and related services under the Individuals with Disabilities Education Act (IDEA), are met in as timely and seamless manner as possible. The vast majority of these children will be attending a different school this year, most likely in a different state. The President and U.S. Department of Education have announced a number of initiatives aimed at helping schools meet challenges caused by homeless and displaced families and lost documentation and other paperwork (such as individualized education programs [IEPs]. Congress will address many of these and other posthurricane issues over the coming weeks. AOTA is working with Congress and the Department to ensure appropriate inclusion of occupational therapy in postrecovery efforts. In the meantime, occupational therapists and occupational therapy assistants who work with children have an important role in helping to address children's psychosocial needs related to the aftermath of the storm. In times of great stress or disaster AOTA members can help students cope with the tragedy that they and their loved ones and friends-or family members or friends who lived in the affected area-are experiencing.
Congressional Relief for Hurricane Katrina
It seems that nearly every Senator and Representative has weighed-in on how to provide the much needed relief for the Gulf Coast area in the aftermath of Hurricane Katrina. Although partisan bickering continues, several bi-partisan efforts have succeeded in bringing immediate relief to the victims of the disaster. Among these were immediate funding for the frontline responders and management agencies guiding the initial relief effort. So far Congress has dedicated over $63 billion toward the emergency relief efforts with estimates growing from $100 billion to a possible total of $200 billion Federal dollars for the complete rebuilding effort.
The longer-term impact of the disaster and its impact on Federal and State Budgets remains unclear, as does its impact on legislation and government programs. Taxes and Medicaid are issues facing significant controversy during this tumultuous time between emergency relief and long term-planning. Republicans remain interested in following through with tax cuts and savings in the Medicaid program whereas Democrats want to expand Medicaid to meet the increased needs of disaster victims and abandon tax cuts because they see them as too expensive at this time of dramatically increased spending.
AOTA will continue to work on these issues as they develop and be sure to be a voice for affordable access to health care and good policy in both the short and long term.
Therapy Cap Discussions Continue
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 $1,740.00 cap on Part B outpatient occupational therapy. AOTA encourages all occupational therapists, occupational therapy assistants, and students of occupational therapy to contact their Congressperson and two Senators and encourage their support by cosponsoring the Medicare Access to Rehabilitation Services Act of 2005 (S. 438/H.R. 916). Use the Legislative Action Center to contact your Representatives and ask for their support.
AOTA will continue to work with the TriAlliance (AOTA, 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. Although there are only a few of us, there are hundreds or 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.
Come to Washington for a Capitol Hill Day!
Come join your colleagues, friends, and fellow occupational therapy practitioners and students on Capitol Hill in Washington, DC. from now until Congress adjourns, which could be as late as December. AOTA's Capitol Hill Day Kick Off is scheduled for September 27, 2005. AOTA members and students are invited and encouraged to come to Washington and meet with their elected Representatives to discuss issues important to occupational therapy. Call and let the AOTA Federal Affairs staff know you want to come to DC for a legislative briefing and Hill day anytime this fall.
AOTA will hold a legislative training session on the morning of September 27, 2005, at the AOTA office building in Bethesda, Maryland, from 8:00 a.m. to 10:00 a.m. AOTA staff will provide a briefing on all the issues, go over talking points, and give each participant a folder of information to hand out on the Hill.
Participants are responsible for setting up their own meetings; however, AOTA staff is able to guide anyone who needs help. We advise that you set up your meeting any time between 10:30 a.m. to 4:30 p.m. After your last meeting, you are on your own.
Contact AOTA legislative representatives Dan Jones or Tim Nanof if you have any questions or concerns at fad@aota.org or 1-800-SAY-AOTA. They can also answer questions about airports and hotels.
IDEA Proposed Regulations
September 6, 2005, marked the end of the public comment period for the U.S. Department of Education's proposed regulations for Part B of the 2004 amendments to IDEA. AOTA's comments on the proposed regulations addressed issues related to personnel qualifications; early intervening services; evaluation procedures; development of the IEP and IEP team meeting attendance; procedural safeguards issues, including parent participation in making decisions about their child's educational needs; and discipline. Proposed regulations for Part C and D are expected to be published in the Federal Register very soon. The Department hopes to release final Part B regulations by the end of the year, although it is not unreasonable to see that deadline shift to early 2006. AOTA will post information on the Web site and in OT Practice when the regulations are available.
Other Department of Education News
In response to a recent request from the Institute of Education Sciences (IES)-the Department's research arm-AOTA submitted comments on their proposed research priorities on August 16. In addition to a stand-alone priority for research on related services, AOTA recommended IES undertake research projects that would confirm what we know, investigate what we don't know, and add to the knowledge base regarding the relationship of related services to child outcomes and student results.
National School Backpack Awareness Day
September 21, 2005, is National School Backpack Awareness Day. Across the country and indeed the world, occupational therapists and occupational therapy assistants are expected to conduct over 900 events and reach over 150,000 children. Senator Susan Collins (R-ME) and Representative Mike Rogers (R-MI) both made statements for the Congressional Record in support of National School Backpack Awareness Day and highlighting the contributions of occupational therapy to our nation's youth.
At Backpack Awareness Day events, which will be held in schools, stores, hospitals, shopping malls, and a variety of other venues, occupational therapy practitioners will weigh in children and their backpacks to make sure that the backpacks do not surpass 15% of the child's body weight. The therapists will provide guidance about how to properly load and carry a backpack and will also share tips about how to stay healthy and succeed in school. This year's event almost tripled in size and has served as a wonderful opportunity to demonstrate the presence and importance of occupational therapy in America's schools and communities. Find more information on Backpack Day.
Title VII Funding Highlighted After Hurricane Katrina
The Gulf Coast area has long been an underserved community in regard to access to health care providers and services. The effects of the hurricane have compounded the problem and part of the solution is educating more professionals who will be able to serve in that and all other underserved areas. The disaster of Hurricane Katrina not only highlighted the need for better preparedness across the country but also demonstrated the horrible effects of disasters in medically underserved and economically deprived areas. Programs funded by Title VII seek to address that issue and comprise an important part of relief efforts for the Gulf Coast and all other underserved areas as well such as much of rural America, inner cities, and Native American reservations.
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. Watch the Legislative Action Center for any new developments.
Pay-for-Performance Update
August and September have been busy with off-the-Hill meetings in regard to pay-for-performance (P4P) under the Medicare program. AOTA Federal and Regulatory and Reimbursement Policy Department staff have participated in a number of meetings with physician and nonphysician groups to discuss the Centers for Medicare & Medicaid Services' (CMSs') plans for a P4P initiative in 2006. CMS plans to run a demonstration project for physician groups for the beginning stages of P4P during the beginning of 2006. CMS staff plan to continue discussions with the nonphysician groups, including AOTA, in the coming months. House and Senate leaders introduced companion P4P bills at the end of July, but action on these bills this fall depends on efforts to address Katrina relief, appropriations, and reconciliation instructions.
P4P 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. P4P is intended to provide an incentive for physicians and practitioners to use evidencebased practice, improve efficiency, and have better patient outcomes.
AOTA will continue to work with both the physician and nonphysician groups 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.
75% Rule: Defend Access to Inpatient Rehabilitation
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 1 of 13 specific conditions identified in 1984-failing to take into account medical advances of the past 2 decades-in order for a facility to retain IRF status. IRF status gives the hospital the ability to receive adequate Medicare compensation due to the intense rehabilitation services that are provided.
Recently introduced legislation by 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) (S. 1405/H.R. 3373) 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 has expired and is scheduled to increase to 75% over the next two 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.
As part of National Rehabilitation Week, AOTA encourages you to contact your Congressperson and two Senators and ask for their support by cosponsoring the Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005 (S. 1405/H.R. 3373). Use the Legislative Action Center to read more .
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.
9/01/05