Federal Legislative Issues Update - Apr 2007
April 2007
Washington Highlights
Washington has been relatively quiet this April. The House of Representatives recessed for the two weeks while the Senate recessed for one week after Easter. The slow time allowed AOTA Federal Affairs staff to meet with key congressional staff members, including Ways and Means and Energy and Commerce Committee staff, to discuss therapy caps, OT in home health, incident-to legislation (read more below), and mental health in Medicare.
Other items on the congressional agenda for April are hearings to look into the reauthorization of the prescription drug user fee act, access to veteran's health, and sorting through the Medicare Payment Advisory Committee's findings on Medicare program efficiency and integrity. Congress will also be overwhelmed with the politics behind an effort by Democrats to pass legislation on supplemental appropriations for Iraq, Afghanistan, continued Katrina cleanup, and other items. President Bush has threatened a veto on the measure because it includes language setting a timetable on troop pullout.
Congress will continue with the budget and appropriations process. Both chambers of Congress have expressed their intent to finish a budget resolution setting spending target for Appropriations Committees by May 15.
Read more below about issues before Congress and AOTA's efforts to bring occupational therapy into the forefront.
AOTA Opposes Recently Introduced "Incident-to" Legislation
The Access to Physical Medicine and Rehabilitation Services Improvement Act of 2007 (H.R. 1846) was recently introduced in the House of Representatives by Representative Edolphuous Towns (D-NY). The legislation would allow non-qualified therapists to bill the Medicare program for therapy services "incident-to" the physician's professional services, thereby eroding the May 2005 Centers for Medicare and Medicaid Services (CMS) regulations that restrict the billing of therapy services under Medicare to those qualified to deliver occupational therapy, physical therapy, and speech language pathology services. This legislation would allow the billing of services provided by athletic trainers and lymphedema services at 80% of the physician fee schedule and would apply the therapy cap limitations to these services. Legislators in the Senate are currently debating introducing the legislation for the 110th Congress in the Senate.
AOTA strongly supports Medicare's qualifications standards. Services reimbursed as occupational therapy should be provided by an occupational therapists or an occupational therapy assistant under the supervision of an occupational therapist.
AOTA urges you to contact your members of Congress to oppose this legislation. Go to AOTA's Legislation Action Center http://capwiz.com/aota/issues/alert/?alertid=9424141
to read more about the bill and its impact on occupational therapy. The Action Center provides a form letter and contact information for your members of Congress. Contact them today to let them know your position.
Home Health Qualifying Service
AOTA recently met with key staff on the House Ways and Means Committee and discussed occupational therapy in home health under Medicare. Currently, occupational therapy is not a qualifying service for Medicare home health benefits as it is in every other post acute setting. AOTA is working with committee staff to develop a consensus with other stakeholders to identify the best way to move AOTA's home health agenda forward. Previous efforts to pass legislation, titled the Medicare Occupational Therapy Coverage Eligibility Act, have been frustrated because the bill is viewed by the Congressional Budget Office as an expansion to Medicare coverage that would cost money to implement. Given the tight budget environment and under pay as you go rules that require offsets for any increases in funding, moving legislation that costs money is difficult even if the end result would improve access to quality care and improved outcomes for beneficiaries.
AOTA is exploring initiatives to improve outcomes data related to OT in home health and to work collaboratively with home health agencies and other providers to expand the role of OT in home health both through policy and practice initiatives.
Medicaid
Federal Affairs staff has been taking the lead in educating Congress about the negative impact of a new regulation restricting reimbursement for the rehabilitation services option under Medicaid. The Centers for Medicare and Medicaid Services have not released the regulation yet but are expected to do so in the fall. AOTA believes the new regulation will dramatically reduce the availability of community based services for people with mental illness, developmental disabilities, and mental retardation. While occupational therapy is typically billed under the distinct OT benefit, which is a state option, many OTs and OTAs work in community-based settings that also bill under the rehab option and certainly work with clients who would be negatively affected by narrowing the definition of rehabilitation services.
AOTA has met with several members of Congress with an interest in community mental health care and is working in coalition with consumer and provider organizations to oppose the proposed regulation. Through that effort, Federal Affairs staff met with the lead health policy counsel for the Senate Finance Committee, which has jurisdiction over Medicaid and other health care issues, and discussed the rehabilitation option and specific concerns provided through collaborative work with the Ohio Occupational Therapy Association (OOTA). AOTA will continue to work on this issue to protect access to community-based supports and services to Medicaid beneficiaries with mental illness, developmental disabilities, and mental retardation.
AOTA Meets With the Director of the Office of Special Education Programs
AOTA Federal Affairs staff had an informational meeting with the Director of the Office of Special Education Programs (OSEP) under the Department of Education, Dr. Alex Posney. OSEP is the federal program responsible for implementation of special education law and is the group that provides guidance to states for services to students with disabilities in both early intervention and school-based settings. Dr. Posney was very familiar with occupational therapy and welcomed our visit. She also responded positively to several of our suggestions on how both Congress and the Department of Education could better integrate occupational therapy into both general and special education to improve outcomes for all students. AOTA will continue to work with OSEP and engage the Department of Education to advocate for our profession.
AOTA Prominent in a Congressional Hearing Related to How NCLB Affects Students with Disabilities
AOTA had a statement entered into the Congressional Record by Representative Phil Hare (D-IL) during a hearing of the Early Childhood, Elementary and Secondary Education Subcommittee of the House Education and Labor Committee on how the No Child Left Behind (NCLB) Act affects students with disabilities. AOTA's comments promoted the role of occupational therapy in addressing psychosocial and behavioral issues in schools and encouraged the inclusion of models like Positive Behavioral Supports (PBS) in the reauthorization of NCLB.
After entering AOTA's statement into the Congressional Record, Representative Hare read part of the statement related to PBS and based his question to the panel on AOTA's recommendations. The panel unanimously supported AOTA's suggestions and expanded on the role of including related service providers in school-wide efforts to improve academic and behavioral outcomes of students with disabilities. AOTA continues to advocate educational issues and connect them with all areas of practice where occupational therapy has expertise and knowledge that can be used to benefit all students. AOTA's Statement for the Record is available on AOTA's Web site in the Advocacy Section under Practitioners.
Legislation to Fix Medicare's "In the Home" Restriction Introduced in the House
Representatives Jim Langevin (D-RI) and Jim Ramstad (R-MN) recently introduced legislation to modify Medicare's "in the home" restriction on mobility devices in the House of Representatives. The Medicare Independent Living Act of 2007 (H.R. 1809) would significantly improve community access for Medicare beneficiaries with mobility impairments by removing a discriminatory restriction that bases the coverage of mobility devices solely on an individual's mobility needs inside their home.
Currently, Medicare only provides coverage for mobility devices that are necessary for use inside a beneficiary's home. In other words, Medicare will grant coverage for a wheelchair or "scooter" that a person needs in order to brush their hair or cook their dinner, but will not provide them with a device if they need it to get to their physician's office, attend their place of worship, go to the grocery store, return to work, or simply participate in community activities.
AOTA needs you to contact your members of Congress to voice your support to pass legislation that will change this rule. Go to AOTA's Legislative Action Center at http://capwiz.com/aota/issues/alert/?alertid=9637746 to contact your members of Congress.
AOTA Submits Principles for Reauthorization of NCLB to Congress
AOTA was asked by the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Education and Labor Committee to submit recommendations for the reauthorization of the No Child Left Behind Act (NCLB) that is expected to take place later this year. AOTA's principles for reauthorization urge the continued alignment of NCLB with the Individuals with Disabilities Education Act (IDEA). Occupational therapy has historically had a more significant role in special education rather than general education but recent changes under IDEA have made it possible for occupational therapists to get federal funding to work with general education students struggling academically and/or behaviorally. Among AOTA's many recommendations were an expansion of early intervening services, which are services provided to school-aged general education students who need additional supports to succeed educationally. AOTA continues to work with Congress to ensure the voice of occupational therapy is heard as Congress takes up reauthorization of NCLB later this year.
AOTA's comments are available on AOTA's Web site in the Advocacy section.
Public Policy Sessions at AOTA's Annual Conference in St. Louis
Understanding and Asserting the Occupational Therapy Scope of Practice
This session will examine the foundations of and challenges to the occupational therapy scope of practice through the use of current state issues and practice situations. Examples of effective strategies used by AOTA, state associations, and practitioners to address these issues will also be shared. The session will help participants identify and deal with scope issues in their workplaces by presenting a reasoning framework to address questions about whether a practice area or intervention is within the occupational therapy scope of practice.
Medicare Update
During this session, staff will highlight the hot topics at Centers for Medicare and Medicaid Services over the past year and provide tips on how attendees can get Medicare to listen to them. Attendees will hear directly from Centers for Medicare and Medicaid Services on coverage, payment, documentation, and ways to avoid denials.
Home Health Policy and Practice
Occupational therapy has long been underutilized as a home health service under Medicare and other programs. This session will discuss the policy issues in occupational therapy that affect occupational therapy practice in home and community based care. Policy issues, such as occupational therapy as a qualifying service and new opportunities under Medicaid will be detailed. Strategies for occupational therapists and occupational therapy assistants to advocate for the profession in home health agencies will be discussed from both policy and practice perspectives.
Durable Medical Equipment Accreditation
Hear from representatives from several accreditation organizations, including CARF, NBAOS, ACHC, CHAP, and JCAHO. Occupational therapy practitioners who fabricate orthotics and bill Medicare under the L-codes will be required to meet accreditation standards as defined in the new Centers for Medicare and Medicaid requirements for durable medical equipment, orthotics, prosthetics, and supplies. Participants will learn about the CMS supplier accreditation requirements published in regulations in August 2006, including quality criteria, timeline, and costs for accreditation.
Medicare on the Hill: How Legislation Will Affect Practice
Congress considers legislation that changes Medicare benefits, payments, access, and coverage requirements. These issues affect the day-to-day practice of occupational therapy. Recent and upcoming legislation in Congress affecting Medicare in hospitals, outpatient settings, home health, nursing homes, and other venues will be reviewed for policy content and for its prospects of being enacted into law. Implications for occupational therapy practice will be discussed as well as ways practitioners can adapt to Medicare changes.
Grassroots Activism---How to Promote the Occupational Therapy Agenda at the State and Federal Level
Elected officials at all levels of government are crafting policies that affect the profession of occupational therapy. How do we make our voice heard against the many different interests that are vying for the attention of lawmakers? Participants in this short course will learn methods to communicate with lawmakers, tools to garner media attention for a legislative agenda, and strategies to educate the public and lawmakers on the importance of occupational therapy.
Policy Issues for Occupational Therapy in Mental Health
This session will discuss policy issues related to occupational therapy and mental health from a state and federal perspective. Issues such as expanding the role of occupational therapy, core, and qualified mental health provider status, and mental health parity legislation will be addressed.
Most AOTA staff will be attending the AOTA Annual Conference in St. Louis starting April 17, but if you need assistance from the Federal Affairs Department, please contact fad@aota.org or 1-800-SAY-AOTA and ask for the Federal Affairs Department.
Annual AOTPAC Night: Party in St. Louis
Come party with your friends and colleagues while you support the political purposes of your AOTPAC. Enjoy music and dancing, a cash bar, and snacks. Help us celebrate the political and advocacy success of the occupational therapy profession.
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.
Last Update: 4/19/07