Federal Legislative Issues Update - May 2007
Washington Highlights
Lawmakers will make a strong push to complete a number of legislative items prior to the Memorial Day Recess on May 28. Many Washington pundits believe that the Democratic Party needs to pass some significant legislation soon, possibly within the next two months, or a least by the end of the fall before the second half of the110th Congress begins in 2008 and presidential positioning dominate the congressional schedule. Since President Bush vetoed a recent Iraq supplemental appropriations bill that included funding for the troops as well as a withdrawal timetable, and the current funding is expected to only last until the end of May, Congress’ highest priority is passing a new supplemental bill to add more funds for the war in Iraq and Afghanistan.
Congress has the remainder of May, June, and July, with the exceptions of Memorial Day and Independence Day recesses, to complete or make significant progress on a host of other important issues. Lawmakers expect to complete work on passing the $2.9 trillion FY2008 budget resolution and appropriations bills, immigration legislation that might include visas for foreign trained therapists and work on a bill that would address issues in Medicare, Medicaid, and SCHIP.
Read more below about other developments in Washington that are making an impact on the American Occupational Therapy Association’s (AOTA) legislative agenda, including, a date for AOTA’s 2008 Capitol Hill Day, the release of the Individuals with Disabilities Education Act (IDEA) Part C regulations, AOTA testimony, and a number of other legislative items with action.
AOTA’s 2007 Capitol Hill Day Scheduled
AOTA will hold the 2007 Capitol Hill Day on Monday, September 17, 2007. As in previous years, AOTA will host a legislative briefing at 8am that morning, location to be announced at a later time. The briefing will include an overview of the legislative process, briefing on the issues to discuss in your meetings, and materials for participants to leave with the staff they meet with. This morning briefing will give everyone an opportunity to socialize with colleagues over coffee and juice and give you the opportunity to ask questions.
In preparation for the Hill Day, participants will need to make their own travel and lodging arrangements. Also, while AOTA staff will be ready and willing to assist, everyone is expected to set up their own meetings with their members of Congress and/or their staff. Contact the Federal Affairs Department for FAQs and helpful hints for setting up meetings.
There will be more details to come, but make your plans NOW to come to Capitol Hill on September 17 to advocate for your profession. Contact Dan Jones at djones@aota.org with any questions in the meantime. RSVPs will be requested by the beginning of September. Read more on AOTA’s Legislative Action Center at http://capwiz.com/aota/issues/alert/?alertid=8612036
IDEA Part C Proposed Regulations Released by the Office of Special Education Programs: New Federal Guidance Related to Early Intervention
On May 9, 2007 the Office of Special Education Programs (OSEP) officially released new proposed regulations related to Part C of IDEA governing early intervention services. The regulations mark the first update to rules related to early intervention since the law was reauthorized in both 1997 and 2004.
AOTA Federal Affairs and Professional Affairs Department staff are busy analyzing and preparing comments regarding the proposed regulations that are still open to comment and adjustment.
The Department of Education (DOE) will also hold public meetings regarding the proposed regulations at the following times and in the following cities:
- June 4, 2007, 4:00 p.m. to 7:30 p.m., Portland, Oregon
- June 6, 2007, 4:00 p.m. to 7:30 p.m., Oklahoma City, Oklahoma
- June 11, 2007, 4:00 p.m. to 7:30 p.m., Indianapolis, Indiana
- June 14, 2007, 3:00 p.m. to 7:30 p.m., Washington, DC
AOTA encourages practitioners to attend and participate in the meetings. AOTA will be working with the School System Special Interest Section and other leaders in the profession to identify specific speakers and to develop AOTA’s official comment on the proposed Part C regulations, which are due to DOE by July 23, 2007.
Additional information is available on the Office of Special Education and Rehabilitation Services website at: http://www.ed.gov/news/pressreleases/2007/05/05042007.html
Grassroots Push for Therapy Cap Repeal Sponsors Needed
As of May 18, the Medicare Access to Rehabilitation Services Act of 2007 (S. 450/H.R. 748) has garnered 90 cosponsors in the House and 24 in the Senate, as opposed to last Congress’ bill that garnered 260 in the House and 45 in the Senate. While we are off to a good start in building the necessary support needed to get action on the therapy caps in 2007, but we will need a stronger grassroots push from now through the summer to ensure Congress has the attention of the therapy community. The Senate and House Committees with jurisdiction over the caps are beginning the process of crafting a large bill that will likely include many Medicare, Medicaid and SCHIP items. APTA is schedule to hold their annual Capitol Hill event the week of May 21, with the therapy caps at the top of their agenda. AOTA members must ensure the occupational therapy voice is heard on Capitol Hill too.
AOTA members need to contact their members of Congress now and again throughout the summer to show support and urgency to address the therapy caps. Use the AOTA Legislative Action Center to find your members of Congress and register your support by sending them an email (form letter included on Action Center), making a telephone call, or scheduling an appointment to meet with them or their staff in Washington or in the district.
Contact AOTA’s Federal Affairs Staff with any questions or comments at 1-800-SAY-AOTA or fad@aota.org.
AOTA’s Submitted Testimony for Congressional Hearings
The following statements were submitted to various Senate and House Committee’s for hearings that involve occupational therapy. A copy of the statements will be available on the AOTA Web site once the site makes its conversion later this summer. For a copy of any of these statements, please contact AOTA’s Federal Affairs Department at 1-800-SAY-AOTA or fad@aota.org.
Hearing on Mental Health and Substance Abuse Systems of Care: Community Integration and Recovery
AOTA submitted a statement entered into the record of a Senate Health, Education, Labor and Pensions (HELP) Committee hearing on mental health and substance abuse. The statement discussed the role of occupational therapy in mental health and substance abuse treatment under a medical model and under the more holistic recovery and rehabilitation models.
The statement went on to promote collaboration among mental health and substance abuse professions and supported multi-disciplinary interventions. Occupational therapy’s focus on maximizing function and performance was also prominent in the statement. More information about the hearing is currently available at: http://help.senate.gov/Hearings/2007_05_08/2007_05_08.html
The Nursing Home Reform Act Turns Twenty: What has been accomplished, and what challenges remain?
AOTA was able to provide comment to the Senate Special Committee on Aging regarding the Nursing Home Reform Acts accomplishments and challenges. The basic objective of the Nursing Home Reform Act is to ensure that residents of nursing homes receive quality care that will result in their achieving or maintaining their “highest practicable” physical, mental, and psychosocial well-being.
The statement focused on how occupational therapy goes to the heart of the goals of the Nursing Home Reform Act. Our nation’s population of older adults continues to grow and nursing homes will remain an important site of care for people who require constant nursing care and have significant deficiencies with activities of daily living.
AOTA’s statement highlighted the use of occupational therapy services in nursing homes as a critical element to the goal of quality care for nursing home patients, and used the goals in Nursing Home Compare (http://www.medicare.gov/NHCompare/Home.asp?version=alternate&browser=IE%7C6%7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True) to show how occupational therapy’s role in ADLs/IADLs, falls prevention, positioning, eating, feeding, and swallowing will help nursing home meet those quality goals.
Examine VA’s Long-Term Care Programs
With the aging of our nation’s Veterans, quality long-term care programs to assist those who are in need should be a priority for our country. AOTA submitted a statement to the House Veterans Committee on occupational therapists and occupational therapy assistants work in long-term care settings, including home and community based settings, to increase the independence and quality of life of their patients.
The statement focused on the role of occupational therapy in helping people remain independent and to successfully age in place. Specific recommendations were made to include occupational therapy in programs were the therapists could use their expertise in improving ADLs/IADLs, home modifications, and older driver assessments. The importance of occupational therapy in nursing homes was also highlighted as an area of care to be reexamined under the VA.
Options to Improve Quality and Efficiency Among Medicare Physicians
AOTA took the opportunity to provide comment on what AOTA is doing in order to improve efficiency among occupational therapists in Medicare by submitting a statement to the House Ways and Means Health Subcommittee hearing on options to improve quality and efficiency among Medicare physicians. AOTA’s statement highlighted some areas in Medicare where the Committee should focus its attention, particularly in regard to AOTA’s efforts relating to the physician quality reporting initiative (PQRI) and the Medicare Part B outpatient therapy caps.
Payments to Certain Medicare Fee-for-Service Providers
The House Ways and Means Health Subcommittee recently held their hearing on payments to certain Medicare fee-for-service providers. AOTA drafted a statement to include in the record for the hearing urging the committee to consider legislative and regulatory changes for a number of issues that impact occupational therapists, including issues relating to the Medicare Part B therapy caps, inpatient rehabilitation 75% rule, and the home health qualifying service.
AOTA Promotes the Role of OT in Psychosocial Rehabilitation with the Veteran’s Administration
AOTA is working with the Veteran’s Administration’s (VA) Office of Academic Affairs and the Chairman of the House Veteran’s Affairs subcommittee, Representative Mike Michaud (D-ME), to include occupational therapy in a newly developed Interprofessional Fellowship in Psychosocial Rehabilitation under the VA.
The initial proposal calls for specific professions including masters and doctoral applicants from rehabilitation professions. AOTA is clarifying and promoting the role and unique contributions of occupational therapists with Congress and the VA, particularly with program directors who are choosing the fellows. AOTA will be providing more information to program directors and AOTA members soon but interested members can also check the VA website for more information at: http://www.veteranrecovery.med.va.gov/rehab/fellowship.pdf
The Institute of Educational Science Announces a Request for Applications Regarding Related Services and Other Areas of Interest of Occupational Therapy Researchers
The Institute of Educational Science (IES) released a Request for Applications (RFA) just before AOTA’s annual conference concerning related services, autism, Response to Intervention (RtI) and a host of other educationally relevant topics. AOTA has disseminated this RFA to program directors and the Administration and Management (AMSIS) and the Education Special Interest Sections (EDSIS), where many of the professions most prominent researchers participate. The related service grant will be offered by the National Center for Special Education Research (NCSER) which is a part of IES.
AOTA is also working with the National Alliance of Pupil Service Organizations (NAPSO) to develop an application reflective of multi-disciplinary research on related services efficacy. Information about NAPSO can be found at: http://www.napso.org/
More information about IES can be found at:
http://www.ed.gov/about/offices/list/ies/index.html
The specific RFA is located at:
http://www.ed.gov/legislation/FedRegister/announcements/2007-2/040607c.html
Incident-to Legislation for Athletic Trainers Remains Hot Topic
The Access to Physical Medicine and Rehabilitation Services Improvement Act of 2007 (H.R. 1846) was 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.
AOTA Opposes Truth and Transparency Legislation
Representative John Sullivan (R-OK) recently reintroduced legislation entitled the Truth and Transparency Act of 2007 (H.R. 2260). AOTA, in coalition with PARCA, a coalition of non-MD/DO providers, have joined together in opposition to the legislation. The bill applies sanctions against misleading statements regarding credentials, training, or skills to all health care providers, excluding medical doctors and osteopathic physicians, AOTA agrees that individuals who are not qualified and/or no appropriately licensed to provide health care services should not be permitted to serve patients. Commercial fraud and misrepresentation are already prohibited by federal and state laws. H.R. 2260 will only create confusion for consumers and may even limit availability of care.
Continue to watch the AOTA Legislative Action Center for more details on this legislation.
New Phase-In towards the 75% Rule Looms
As part of the Deficit Reduction Act of 2005, the Congress directed the Centers for Medicare and Medicaid Services to begin a phase-in of the 75% Rule for inpatient Rehabilitations Facilities. The current threshold is at 60% and will increase to 65% on July 1, 2007, and then go to the full 75% on July 1, 2008.
The Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 (S. 543). would permanently "lock in" the current 60 percent compliance threshold required of inpatient rehabilitation facilities' (IRF) patient populations.
The regulation, commonly known as the "75 percent rule," will require at least 75 percent of an IRF's patient population to have 1 of 13 designated medical conditions for which intensive inpatient rehabilitation services are medically necessary.
Go to the AOTA Legislative Action Center at http://capwiz.com/aota/issues/alert/?alertid=9417701&type=CO to write your members of Congress and ask for their cosponsorship of this legislation.
Institute of Medicine releases report: The Future of Disability in America
In light of the expanding elderly population in the U.S., a better system is needed to provide care for the disabled, according to a report released Tuesday by the Institute of Medicine. The report estimates that more than 40 million U.S. residents are disabled in some way. Aging baby boomers are likely to increase the country's disabled population. The report also predicts that younger generations will contribute to the disabled population because of declines in physical activity and increases in obesity and diabetes. The report recommends that Congress and federal agencies:
* Increase funding for research into clinical health services and disability problems, including social and behavioral;
* Strengthen the Americans with Disabilities Act to ensure accessibility at health care facilities for the disabled;
* Eliminate the two-year waiting period for Medicare eligibility for Social Security Disability Insurance beneficiaries;
* Modify the "in-home-use" requirement for Medicare coverage of durable medical equipment to allow reimbursement for equipment that can be used both inside and outside the home;
* Increase educational programs for health professionals that care for the disabled; and Develop a system through the National Center for Health Statistics, Census Bureau and Bureau of Labor Statistics to monitor the number and types of disabled U.S. residents.
To learn more about the report, go to the IOM Web site (http://www.iom.edu/CMS/3740/25335/42494.aspx)
Medicare Trustees Report Issues Funding Warning
On April 23, the Medicare trustees released their annual report (http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2007.pdf) on the current status and projected financial condition of the Medicare program. Of concern for providers and beneficiaries alike is that, for the first time, a funding warning has been activated. According to the Medicare Modernization Act of 2003, a funding warning is triggered when the trustees make a determination in two consecutive annual reports that general revenue will make up more than 45 percent of total Medicare financing within a 7-year period (2007-2013 in this year's report). This determination was first made in the 2006 report, which projected that general revenues would exceed 45 percent of total Medicare financing by 2012. As a result of the funding warning, the Administration is required by law to propose legislation within 15 days of the next federal budget proposal, due in February 2008, to bring the funding level below 45 percent. Congress is required to consider, but does not necessarily have to take action, on the Administration's proposals.
AOTA Continues Work to Restore Title VII Funds
AOTA, in coalition with the Health Professional and Nursing Education Coalition recently set a letter to House Appropriations Chairman David Obey to urge the Committee to fund fully the health professions education programs by providing at least $300 million for Title VII health professions programs. These appropriations provide vital support to programs to fulfill their shared mission of improving the supply, distribution, and diversity of health professionals nationwide.
In FY 2006, funding for the Title VII programs was drastically reduced by 51 percent. For most of the programs, these funding levels were maintained in the FY 2007 Joint Funding Resolution, causing programs across the nation to cease their activities.
Currently, Senators Jack Reed (D-RI) and Pat Roberts (R-KS) have a letter in the Senate available for sign on by other Senators in support of increased funding for Title VII programs. The letter has 37 Senators signed on with nearly a week left for you to call your Senators and ask for their support by signing the Reed-Roberts Title health professions funding letter.
Similarly, the House had a March 16 letter led by Representatives Diana DeGette (D-CO) and Cathy McMorris (R-WA) was signed by 98 Representatives requesting a restoration of Title VII funds.
Continue to watch the AOTA Legislative Action Center of more details involving Title VII funds.
House Passes Genetic Nondiscrimination Bill
On April 25, the House approved the Genetic Information Nondiscrimination Act (H.R. 493), 420-3. The final bill is a compromise of versions approved by three different committees. The bill would prohibit employers or insurers from collecting or using genetic information when making decisions related to hiring, firing, health coverage or insurance premiums.
On January 31, the Senate Health, Education, Labor, and Pensions Committee approved its version (S. 358), but Senator Tom Coburn (R-OK) has placed a hold on the bill. It is expected his concerns will be addressed, and the bill will be passed by the Senate. The President has stated he will sign the bill.
AOTPAC
The AOTPAC Board of Directors held its annual meeting during the AOTA Annual Conference in St. Louis. They developed a fundraising and communication plan, approved a slate of candidates for support, reviewed and discussed activities and programs held throughout the previous year, set a fundraising goal, and planned for the 30th anniversary of AOTPAC in 2008.
Lawrence Zachow, OT of Alabama was appointed to serve on the AOTPAC Board of Directors for Region III, replacing Paul Fontana.
Fundraising at the AOTA Conference was exceptional, raising over $32,000 with receipts and pledges. Thanks to all those from the leadership groups and the attendees for helping us exceed last years conference receipts by 25 percent.
AOTPAC held its annual AOTPAC Night at the annual conference in St. Louis with over 200 in attendance. Participants enjoyed music and dancing and socializing with their colleagues.
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.