Federal Legislative Issues Update - Sept 2006
September 2006
Washington Highlights
As September comes to a close, the congressional agenda still proves to be overly ambitious, with little time left before the October recess when lawmakers head home to begin last-minute campaign activities. On the top of the priority list for AOTA, as well as many other provider and consumer groups, is the need to address the therapy caps and fix Medicare payment rates before January 1, 2007 (read more below). The understanding from congressional leadership at this point is that Congress will return after the elections for a "lame duck" session—the period after the elections but before the newly elected Congress takes office. Congress also plans to address other issues, including association health plans, health information technology, appropriations, lobbying reform, and immigration.
October and November present opportunities for AOTA members to meet with their lawmakers in their districts. This is a critical time for AOTA members to weigh in with their elected representatives on issues important to the profession. Contact the AOTA Federal Affairs Department at fad@aota.org or 1-800-SAY-AOTA to learn how you can become more politically active in your area and be a voice for the profession of occupational therapy.
Therapy Cap Update: Call to Action
Senators John Ensign (R-NV) and Blanche Lincoln (D-AR), as well as Representatives Phil English (R-PA), Roy Blunt (R-MO), Ben Cardin (D-MD), and Frank Pallone (D-NJ), introduced the Securing Effective and Necessary Individual Outpatient Rehabilitation Services (SENIORS) Act of 2006 (S. 3912/H.R. 6132) this week to ensure that Medicare beneficiaries who rely on medically necessary services continue to have access to the services they need. The bill would allow exceptions to the therapy caps for certain medically necessary services in 2007, which is the same alternative to the cap currently being implemented. The therapy caps will return on January 1, 2007, if Congress does not take action this year.
Contact your elected officials (1 member of the House of Representatives and 2 Senators) to support the extension of the therapy cap exceptions process by using AOTA's Legislative Action Center. A form letter is provided. All you have to do is submit your mailing address and the system will e-mail your letter to your representatives. You also have the option of tailoring the letter to make it more personal.
Physician Fee Schedule Cuts
AOTA has worked all year with other provider and consumer groups to prevent a schedule cut to Medicare reimbursements. A 5.1% payment reduction for the physician fee schedule, which pays both physicians and non-physicians (including occupational therapists) under Medicare, will take effect on January 1, 2007, if Congress fails to take action. As in past bills, Congress has combined a fix to the fee schedule with a therapy cap fix.
The American Medical Association Large Group Coalition, of which AOTA is a member, has worked feverishly to prevent the cuts before the end of the year. Discussions with congressional leaders and the health care community have been ongoing on how to find a long-term solution to the yearly shortfall of the physician fee payments. The discussions often result in the idea of moving the current payment system to a value-based purchasing system. Because the idea of payments based on quality is relatively new, members of Congress and their staffs continue to hold meetings and hearings to learn more about how such a system might be configured. AOTA has worked to ensure the appropriate representation of rehabilitation in such a discussion and is sure to be an integral part of any future debate regarding payments to occupational therapists. Continue to watch the AOTA Legislative Action Center for updates.
AOTA Capitol Hill Day Kick-Off a Success!
AOTA hosted its annual Capitol Hill Day kick-off on September 5, 2006, with great success. Over 70 participants attended from 10 states for the day's events. The participants came to AOTA headquarters for a legislative briefing and had time to meet with their colleagues. They then left AOTA to go to Capitol Hill for meetings with their representatives and senators for the day. Be sure to pick up the next OT Practice to read a full summary. Also, watch the Legislative Action Center for the announcement of the next Capitol Hill Day with a new date this spring.
National School Backpack Awareness Day Recognized by Congress
Senator Bob Menendez (D-NJ) and Representative Brad Miller (D-NC) recently entered statements into the Congressional Record supporting September 20, 2006, as National School Backpack Awareness Day, and highlighting the contributions of occupational therapy. Both Senator Menendez and Representative Miller have been consistent supporters of occupational therapy. The statements will be available on the "Advocacy" page of AOTA's Web site, after they are published in the Federal Register.
Federal Affairs Staff Participate in the Annual OSEP Leadership Conference
On August 28-30, 2006, Federal Affairs staff participated in the Office of Special Education Programs annual Leadership Conference held in Washington, DC. Attendees included other leaders in the field, such as state special education directors, disability rights advocates, and representatives of other professions concerned about special education and related services for students with disabilities.
The focus of the conference was the newly released Individuals with Disabilities Education Act (IDEA) Part B regulations. The regulations were published in the Federal Register on August 14, 2006.
IDEA Part B Regulation Analysis Completed by AOTA
The Department of Education released the unofficial IDEA Part B regulations on August 3, 2006, and the official regulations were published in the Federal Register on August 14, 2006. AOTA staff have been reviewing the regulations and working with other stakeholders to identify the key changes in the regulations related to Part B of IDEA that provides assistance to states for the education of all children with disabilities. The new regulations do not make sweeping changes, but do create some new opportunities and obligations for occupational therapists and occupational therapy assistants in school-based practice.
A short review of the regulations, as well as a more detailed section-by-section analysis, is now available in the IDEA section of Current Federal Issues located on AOTA's Web site.
National Institutes of Health Reauthorization
The House Energy and Commerce Committee recently held hearings and passed legislation that would reauthorize the National Institutes of Health (NIH) for the first time since 1993. House Energy and Commerce Chairman Joe Barton (R-TX) expects the full bill to come to the House floor the last week of September. The Senate is unlikely to address NIH reauthorization before the November elections. Reauthorization would allow lawmakers to make structural and administrative changes to NIH, in addition to those made indirectly through approval of the agency budget. Under the legislation, the NIH budget would increase by 5% annually for fiscal years 2007 through 2009. The bill also would establish a "common fund" to subsidize research that involves multiple NIH institutes or centers. In addition, the legislation would establish a review board to examine the structure of NIH and would require the agency to implement an electronic system to track research grants and other actions. The bill likely will reach the House Floor for a vote at the end of September.
The National Center for Medical Rehabilitation Research (NCMRR) Coalition, of which AOTA is a strong member, is deeply invested in the enhancement of research to improve the lives of people with physical impairments and disabilities. The coalition successfully worked for the inclusion of provisions increasing attention to and funding for rehabilitation and disability research.
Stay tuned to the Legislative Action Center for more details and updates.
AOTPAC, AOTA Federal Affairs Staff, and Nine Members Represent the Profession at a Political Event in Chicago
AOTPAC sponsored a table at House Speaker Dennis Hastert's (R-IL) Leadership Fundraising event in Chicago on September 8. The event, which was attended by nine local occupational therapy professionals, including the Illinois State President and Federal Affairs staff, was headlined by both Dennis Hastert and by former Mayor of New York Rudy Giuliani. AOTA members had the opportunity to have photos taken with the Speaker, and were also able to show how politically active our members are.
Federal Affairs staff and one local occupational therapist also went to a small reception at the Hastert home the next day and were able to advocate for OT and try to ensure that our issues are on the Congressional leadership's agenda for the remainder of the year.
Federal Affairs Staff Meet with Special Interest Section (SIS) Leaders
On Saturday, September 16, the AOTA Special Interest Sections (SISs) met at AOTA headquarters to hold their fall meetings, and had the opportunity to discuss issues with Federal Affairs staff. Federal Affairs staff participated, at the request of the SIS chairs, with the Mental Health, Administration & Management, School System, and Home Health SISs. The meetings allow both groups to coordinate their efforts on behalf of the profession and to disseminate important information.
Appropriations Update
AOTA is working with congressional staff to increase the funding levels of the FY '07 Labor-HHS-Ed Appropriations bill that provides funds for the National Institutes of Health, Title VII, and various education programs. At this point, the legislation appears to be headed for the lame-duck session. Continue to watch the AOTA Legislative Action Center for details on what you can do to help in securing funding for OT research, training, and education.
Regulatory Changes to Medicaid Threaten Funding and Access To Care for Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) has begun developing new regulations that would limit reimbursement for certain services currently covered by Medicaid. The regulatory changes would also change the way states and the Federal government fund Medicaid, shifting increased costs to states while restricting common ways states currently fund their portion of Medicaid dollars.
Services at risk are those provided under the rehabilitation benefit, and also school-based reimbursement for transportation costs and administrative claiming. AOTA is collaborating with other consumer and provider advocacy groups to oppose these changes. More information about these regulatory changes can be found on AOTA's Legislative Action Center.
Legislation Introduced Addressing the "In the Home" Wheelchair Restriction
Senators Jeff Bingaman (D-NM) and Rick Santorum (R-PA) and Representative Sherrod Brown (D-OH) recently introduced important legislation to modify Medicare's antiquated "in the home" restriction on mobility devices.
The Medicare Independent Living Act of 2006 (S. 3677/H.R. 5983) would significantly increase community access for Medicare beneficiaries with mobility impairments by providing them with mobility devices appropriate not only for daily activities inside their homes, but outside of their homes as well.
The statutory "in the home" language was originally meant to define durable medical equipment (DME) as devices that were provided outside of a hospital or skilled nursing facility and, therefore, warranted separate reimbursement under Medicare Part B. Currently, the language is interpreted by CMS to restrict coverage to only those mobility devices that are reasonable and necessary in the patient's home. Many individuals, however, are able to function without a mobility device inside their homes but need a device for community activities such as attending work, school, religious services, health care appointments, and grocery shopping.
The ITEM Coalition, of which AOTA is an active member, is a consumer-led group of 75 organizations whose mission is to improve access to and coverage of assistive technology, devices, and related services for people with disabilities of all ages. AOTA and the ITEM coalition are continuing to work hard to pass legislation addressing this problem.
AOTA Staff Continue To Work on Expanding the Role of OT in Emergency Preparedness
AOTA and the Affiliated State Associations are working with the Department of Health and Human Services Office on Disability to provide contacts and expertise to states for developing more effective plans for emergency preparedness specific to people with disabilities. This ongoing effort is part of AOTA's plan to expand the role of occupational therapy in emergency preparedness, and is independent of other work being pursued with the American Red Cross, Congress, and the Substance Abuse & Mental Health Services Administration (SAMHSA).
Elder Justice Act and Older Americans Act Updates
Both of these important pieces of legislation have yet to move through the legislative process. The Elder Justice Act (H.R. 4993/S. 2010) has made significant progress in the Senate, but has yet to be addressed in the House. Older Americans Act Reauthorization bills (H.R. 5293/S. 3570) have passed both chambers, but must be reconciled in Conference. Congressional leaders have stated their intent to move this legislation before the October recess but there is currently little movement on either issue, and time is running out. It is also possible that the bills can be passed after the November elections during the "lame duck" session, but the amount of work building up for that period can make final passage questionable. More information and updates will be on AOTA's Legislative Action Center.
AOTPAC
The November 7 elections are closing in and AOTPAC still needs your help to make this an even more successful election cycle. We need you to make a contribution to AOTPAC—you can make one online or download and mail the contribution form.We still need $70,000 to reach our goal for 2006. Please help today!
Remember to vote on November 7, because your vote does count! See the candidates that your AOTPAC supports under AOTPAC in the Advocacy section of the www.aota.org web site . (You'll need Adobe Reader to view this document.)
OT Food for the Soul Cookbook
Thanks to the students at Touro College in New York, who conducted a great fund-raiser with proceeds going to AOTPAC. The students made an initial contribution of more than $1,700 and hope to do more. For the fund-raising activity, students and faculty members contributed their favorite recipes, which were then combined into a cookbook, OT Food for the Soul. The cookbook includes 150 new and exciting recipes that can be used with clients or just for dinner. Proceeds go to support the political purposes of AOTPAC. If you would like to participate in these fund-raising efforts, you can purchase the cookbook for only $13.00, plus $5.00 for shipping and handling anywhere in the United States and $6.00 in Canada, per book. Please send a personal check or money order to OT Cookbooks, 132 Walraven Drive #3A, Teaneck, NJ 07666 and specify the number of cookbooks that you would like and the address that they should be sent to. The cookbooks will be mailed within 7-10 days. If you have any questions or comments, you can e-mail them to . This is bound in a beautifully designed binder cover and would make a great addition to your shelf and culinary library.
10/18/06