Federal Legislative Issues Update - June 2006
June 2006
Washington Highlights
Congress continues to push through a heavy legislative agenda in May and June. As discussed below, AOTA has been able to ramp up debate on the need to address legislation on therapy caps in 2006. Congress has tackled many major pieces of legislation, including immigration reform, tax legislation, and supplemental appropriations for Iraq and the Gulf Coast relief efforts.
Additionally, congressional leaders recently declared June 19 as another "health week," with possible debate and votes on health information technology legislation, National Institutes of Health reauthorization, Older Americans Act reauthorization, and the Ryan White Act reauthorization.
Time is ticking quickly on the remainder of the legislative session prior to this year's election. With only 3 weeks in July and a politically charged 4 weeks in September, time is limited to complete a laundry list of issues, including Medicare. Read on to learn about opportunities to have Medicare legislation, including the therapy caps, addressed in 2006. Make your plans today to come to Washington, DC, for AOTA's Capitol Hill Day. Go to AOTA's Legislative Action Center to read more about it.
Reminder: Please go to the following link to participate in a survey that will help AOTA staff determine the best method of communication of the monthly Federal Legislative Issues Update. The survey should take less than 5 minutes.
http://www.zoomerang.com/survey.zgi?p=WEB225BFT24RXS
Therapy Cap Discussion Heats Up in Washington
On May 26, members of the House of Representatives and the Senate joined in an effort to request their leadership to consider passing legislation in 2006 to address the Medicare outpatient therapy caps. The letter sent to leadership gained 176 signers in the House of Representatives and 46 signers in the Senate. Legislation to repeal the caps, the Medicare Access to Rehabilitation Services Act of 2005 (H.R. 916/S. 438), has gained the support of 45 Senators and 252 members of the House of Representatives.
The Deficit Reduction Act of 2005 required the Centers for Medicare & Medicaid Services (CMS) to create the exceptions process, but only for 2006. The congressional letter sent to leadership requests an extension of this exceptions process for at least 2007. This will allow CMS, Congress, AOTA, and other provider and consumer groups to continue to work toward an appropriate long-term solution to the caps. If Congress fails to act this year, the arbitrary therapy caps will return on January 1, 2007, and will result in restricted access to rehabilitation services.
The Hill, a weekly newspaper covering Congress, has recently published two articles highlighting the recent activity regarding the therapy caps. The articles discuss the reluctance of Congress to address Medicare legislation prior to the November elections, and the likelihood of Medicare-related issues, including the therapy caps, to be addressed in a lame duck session-the time after elections and before Congress adjourns. Other Medicare issues to be addressed this year are the need to extend the enrollment period for Medicare Part D, health information technology in Medicare, and the Medicare physician fee schedule fix.
The TriAlliance (AOTA, APTA, and ASHA) recently circulated an organizational sign-on letter similar to the congressional letter that will be sent to the House and Senate leadership. The TriAlliance letter differs from the congressional letter in that it asks leadership to extend the exceptions process for at least 2 years instead of 1 in order to allow time to review data to implement a long-term solution.
Urge Congress to support legislation addressing the therapy caps in 2006 by contacting your elected representatives (2 Senators, 1 member of the House of Representatives) today! Go to the AOTA Legislative Action Center at http://capwiz.com/aota/issues/alert/?alertid=8460616 to contact your members of Congress.
Take the Medicare Part B Outpatient Therapy Cap Exception Process Survey Today!
Help AOTA gather data on the therapy cap exceptions process by going to the following link to take the Zoomerang survey. Your answers will help AOTA staff in discussions with Congress, CMS, and other provider groups in the coming months. Go to http://www.zoomerang.com/survey.zgi?p=WEB2258T2TGZY7 to take the survey.
Appropriation Victories in the House
The House Labor-HHS [Health & Human Services]-Education Appropriations Committee on June 13 approved its FY 2007 spending bill. The bill provides $141.9 billion in discretionary funding, a $4.136 billion increase over the President's budget. The bill provides $28.25 billion for the National Institutes of Health (NIH) and $6.1 billion for the Centers for Disease Control and Prevention. The bill includes $163.6 million for Title VII health professions, a 12.7% increase above FY 2006, and restores the geriatric funding to the FY 2005 level of $31.5 million. The Centers for Health Workforce Studies was eliminated in the FY 2006 budget and not restored in the Committee. The bill now is ready for the House floor as soon as leadership schedules floor time.
The bill also provides $106.7 million for the National Institute for Disability and Rehabilitation Research within the Department of Education, the same as last year's level.
The Senate is likely to begin debate on its Labor-HHS-Ed appropriations version soon. Advocacy efforts must remain high to ensure that funds are included for all the important health care programs.
Go to AOTA's Legislative Action Center to contact your Senators and ask them to support all these important programs.
Rehabilitation Research
AOTA presented comments before the Interagency Committee on Disability Research, which is an advisory council for disability research funded throughout the Federal government. The Committee is chaired by Dr. Steven Tingus, who is the Director of the National Institute on Disability and Rehabilitation Research at the Department of Education. Representatives from the National Institutes of Health are represented as well.
AOTA's comments focused on capacity building to develop more trained research scientists within the profession and the need to promote outcomes and efficacy research for occupational therapy interventions.
IDEA
AOTA has learned that the long-awaited regulations for Part B of the newly amended Individuals with Disabilities Education Act (IDEA) are in the final approval stage. Although the law went into effect July 1, 2005, the education and disability communities have been anxiously waiting for the regulations, which are the rules about how to implement the law. AOTA provided comments to the U.S. Department of Education (DOE) during the rulemaking process. The final regulations are expected to be published in the Federal Register in August. Watch the AOTA Web site and IDEA Information Center for more information.
On June 5, the DOE quietly released revised regulations on IDEA's payback provisions under the Part D Personnel Development program. The personnel development program provides funding to universities to prepare people to work in special education, early intervention, and related services, including occupational therapy. The new rules, Service Obligations Under Special Education-Personnel Development to Improve Services and Results for Children With Disabilities, describe what requirements must be met by students who receive support under this program. The new rules go into effect on July 5, 2006.
Also on June 5, the Department published three notices of personnel development grants. These grants are intended to help address State-identified needs for highly qualified personnel in special education, related services, early intervention, and regular education to work with infants, toddlers, children, and youth with disabilities, and to ensure that these personnel have the necessary skills and knowledge to serve those children. The grant notices are
Personnel Development To Improve Services and Results for Children With Disabilities-Preparation of Leadership Personnel (CFDA) Number: 84.325D
Personnel Development to Improve Services and Results for Children with Disabilities-Interdisciplinary Training in Analysis of Large-Scale Databases (CFDA) Number: 84.325L
Personnel Development to Improve Services and Results for Children with Disabilities-Combined Priority for Personnel Preparation (CFDA) Number: 84.325K
No Child Left Behind
In anticipation of the reauthorization of No Child Left Behind (NCLB) (itself a reauthorization of the Elementary and Secondary Education Act, or ESEA), the House Committee on Education and the Workforce held a hearing on June 13, 2006, on "No Child Left Behind: Disaggregating Student Achievement by Subgroups to Ensure All Students Are Learning." AOTA federal affairs staff attended the hearing, which was focused on the need to raise student achievement among all minority and disadvantaged students. Republican and Democratic members of the Committee raised concerns over recent reports that test scores of some disadvantaged and minority students are not being disaggregated as part of school and district adequate yearly progress (AYP) calculations under NCLB. AOTA will continue to follow the reauthorization process to determine where and how occupational therapy can best contribute to general education student learning and behavior.
Department of Labor
Federal Affairs staff is working with the U.S. Department of Labor on its Occupational Expert (OE) Data Collection Program for the Occupational Information Network (O*NET). The OE Data Collection Program is gathering information about occupational therapy for the national O*NET database, which is used by employers, workers, educators, and students across the country to learn about the requirements of different jobs, such as occupational therapist. The O*NET database is often used in conjunction with the Department's Bureau of Labor Statistics (BLS) Occupational Outlook Handbook information about different types of jobs for the occupational therapist description).
Home Health Qualifying Service
Following up on the letter circulated last month by the bipartisan sponsors of the Medicare Occupational Therapy Coverage Eligibility Act (H.R. 3022), the bill has gained an additional 8 house co-sponsors in the last month. Although the progress has been important, additional effort is required to build support for this legislation and make OT a qualifying service for Medicare home health benefits.
AOTA is still looking for a Senate sponsor of the bill in order to begin building support for passage in the Senate as well as the House. More information is available on the AOTA Legislative Action Center located at: http://capwiz.com/aota/issues/alert/?alertid=8747506&type=CO
Emergency Preparedness
Federal Affairs staff met with Red Cross Disaster Mental Health and Emergency Preparedness leaders to promote and advance the role of occupational therapy within the Red Cross. The discussion was initiated in a way to get occupational therapists recognized as eligible mental health providers and provided AOTA an opportunity to highlight the role and expertise of the profession in mental health as it relates to emergency preparedness, response, and recovery.
During the meeting, other leaders at the Red Cross met with us to discuss the role of OT and needs of people with disabilities and mental illness. Overall the meeting was productive and further meetings are expected in coming months.
SAMHSA Report of Screening for Mental Illness in Skilled Nursing Facilities
The Substance Abuse and Mental Health Services Administration (SAMHSA) has recently released a report on the Pre-Admission Screening and Resident Review (PASRR) process, which is intended to ensure that residents are placed in the most appropriate setting that can provide for their mental health needs. AOTA reviewed the report with a focus on the professional qualifications required for screeners under the program. PASRR facilitates two levels of screening; Level I provides a broad sense of the resident's cognitive and behavioral function and treatment needs, while Level II provides a more comprehensive assessment of the client's mental health status, including providing or confirming a diagnosis of mental illness as appropriate. Although occupational therapists are included as eligible Level I screeners in many states, the issue of the statutory designation of qualified mental health provider can limit eligibility, particularly under the more stringent Level II requirements. AOTA is continuing to review the report and will submit comment to the originating office. A copy of this report can be found on the SAMHSA Web site at: http://www.mentalhealth.samhsa.gov/publications/allpubs/SMA05-4039/
Medicaid
Federal Affairs staff have been following Medicaid reimbursement issues that have been getting increased attention from various states and the Centers for Medicare & Medicaid Services (CMS). Of particular interest are the areas of reimbursement for school-based services and administrative costs and clarifying reimbursement for the distinct rehabilitation service benefit, which is an optional service under Medicaid. AOTA is working with state associations, state departments of health and human services or related agencies, and CMS to ensure continued access to occupational therapy for beneficiaries in affected settings. Although no substantive policy or regulatory change has happened at the Federal level, problems have been developing, in several states, resulting from the provision of unapproved services and improper documentation or billing. AOTA is working to educate state administrators, CMS officials, and providers to ensure that covered services will continue to be provided to all eligible beneficiaries and that concerns related to accountability are resolved through proper documentation.
AOTA Submits Comments to House Waysand Means Subcommittee on Social Security
On June 15, the House Ways and Means Subcommittee on Social Security held a hearing titled "Social Security's Improved Disability Determination Process." Commissioner of Social Security Jo Anne B. Barnhart has undertaken a comprehensive initiative to evaluate and implement substantive process reforms to the disability determination process. The Social Security Administration (SSA) recently published its final rule on this initiative, to be phased in beginning August 1, 2006. One aspect of the rule is to improve medical and vocational expert access. In the rule, Commissioner Barnhart states that the SSA is studying the recommendation by the Institute of Medicine that encourages the use of licensed medical personnel other than physicians or psychologists, such as occupational therapists, to expand the range of expertise available to adjudicators.
At the hearing, AOTA submitted comments and questions supporting occupational therapists as a vital source of information about the range of issues in determining disability, and supporting occupational therapists inclusion as experts in Social Security's Medical-Vocational Expert System.
Continue to watch the AOTA's Issues and Advocacy section on the AOTA Web site for a copy of the submitted testimony.
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.
6/30/06