Federal Legislative Issues Update - Nov 2007
Washington Highlights
Beginning on Monday, November 19, Congress begins a 2-week recess for the Thanksgiving holiday. This means that when they return on December 3, they will have a total of 15 legislative days, assuming they work on Mondays and Fridays. With a laundry list of items to address, Congress is feeling the pressure to complete legislation addressing Medicare issues, tax extenders, a farm bill, FY 2008 appropriations bills, and numerous other issues.
Read more below about Calls to Action on Medicare legislation, as well as the status of many other issues that will have an impact on occupational therapy.
AOTA Continues To Advocate for OTs To Perform Power Wheelchair Evaluations: Medicare Decision Expected Shortly
The American Occupational Therapy Association (AOTA) participated in a conference call on October 23, 2007, with the following Medicare Durable Medical Equipment (DME) contractor medical directors: Dr. Adrian Oleck of Trust Solutions (Region C); Dr. Paul Hughes of Tricenturion (Regions A & B); and Dr. Mark Pilley of Integriguard (Region D). AOTA, along with the American Physical Therapy Association, discussed a provision of deep concern to occupational and physical therapists that is included in the Medicare DME contractor’s Local Coverage Determination Policy for Power Mobility Devices (PMD).
AOTA has grave concerns that this new policy requirement does not measure a therapist’s competence in performing PMD evaluations and will result in an access problem for Medicare beneficiaries. The Medicare DME medical directors listened to AOTA’s concerns and agreed to issue a decision in this matter by the end of November 2007.
For more information, please go to AOTA’s reconsideration letter to Doctors Oleck, Hughes, and Pilley at http://www.aota.org/Practioners/Reimb/News/Letters/40713.aspx
Medicare Fixes Needed: Grassroots Action Alert
AOTA continues to advocate with other provider and consumer groups in support of freezing the threshold for inpatient rehabilitation facilities, rescinding the 10.1% payment cut to the Medicare Physician Fee Schedule, and extending the therapy cap exceptions process before the end of 2007.
With only 3 weeks left on the legislative calendar, Congress has a lot of work to complete. AOTA needs your help to ensure that Congress addresses the 75% rule, therapy caps, and Medicare Physician Fee Schedule during this time. Congress has a number of Medicare provisions that they would like to include in a bill to be addressed in December, but the size and details of the Medicare package are unknown and are largely dependent on how the bill is financed.
Each one of the following issues was addressed in the Medicare bill passed by the House of Representatives in July. The Senate must act now to pass a Medicare bill, then compromise with the House on any differences—all before December 31! The Senate is scheduled to mark up their Medicare bill on December 5. Stay tuned to the AOTA Legislative Action Center for more details.
Therapy Caps
If Congress does not take action before the end of 2007, the Medicare outpatient therapy caps on physical therapy and speech-language pathology services combined, and a separate cap on occupational therapy services, are set to be implemented on January 1, 2008, at $1,810. AOTA continues to work with House and Senate Committee staff in support of including an extension on the therapy cap exceptions process for 2008 and 2009.
Senators Ben Cardin (D-MD), Susan Collins (R-ME), and John Ensign (R-NV), and Representative Xavier Becerra (D-CA) addressed “Stop the Therapy Cap Day” events sponsored by AOTA along with six other health care organizations on October 31, 2007. More than 100 professionals, practitioners, and consumers visited lawmakers on Capitol Hill to request Congress to stop the Medicare therapy cap from taking effect in 2008.
AOTA continues to need your help in contacting your members of Congress and urging their support for including language that will extend the therapy cap exceptions process for 2 years in Medicare legislation being considered in December.
Use the AOTA Legislative Action Center to contact your members of Congress TODAY at http://capwiz.com/aota/issues/alert/?alertid=10410596.
Physician Fee Schedule
The 2008 Medicare Physician Fee Schedule includes a 10.1% cut to occupational therapy services. AOTA continues work with Congress and other provider groups, including the American Medicare Association’s Medicare Large Group Coalition, to prevent payment cuts scheduled for January 1, 2008. Use the AOTA Legislative Action Center to contact your members of Congress and urge their support to prevent these scheduled cuts at http://capwiz.com/aota/issues/alert/?alertid=10410596.
75% Rule for Inpatient Rehabilitation Facilities
As part of the Deficit Reduction Act of 2005, the Congress directed the Centers for Medicare & Medicaid Services (CMS) to begin a phase-in of the 75% Rule for Inpatient Rehabilitation Facilities (IRFs). The current threshold is at 65% and will increase to the full 75% on July 1, 2008. 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.
The Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 (S. 543/H.R. 1459) would permanently “lock in” a 60% compliance threshold required of IRF patient populations.
The House included the language of S. 543/H.R. 1459 into their Medicare bill passed in July, but similar to language on the therapy caps and the fee schedule, the Senate must pass a bill and compromise with the House while maintaining this language in order for it to be addressed.
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 support for including language to freeze the 75% rule for IRFs at the 60% threshold.
Calling All OT Practitioners in the Veterans Administration: Open Town Hall Meeting
AOTA has scheduled an open “town hall” meeting for occupational therapists and occupational therapy assistants in the Veterans Administration via a conference call on November 29, 2007, at 5:30 p.m. ET for one hour. This is free and open to all. A maximum of 125 phone lines is available (registration details below), first come, first served. Multiple people can listen in on one phone line. The discussion will focus on ways that AOTA can better understand and serve its members who work for the Veterans Administration.
To register, or for more information, please e-mail or call the AOTA Federal Affairs Department at fad@aota.org or 1-800-SAY-AOTA and ask for extension 2010.
Conference Call Information:
The phone number for participants to use is: 1-888-453-5732
Participant passcode is: 309107.
No Child Left Behind Update
No Child Left Behind Reauthorization fell victim to political pressure in anticipation of the upcoming election next year, and a point of contention regarding Pay for Performance between the Education and Labor Committee Chairman George Miller (D-CA) and the large teachers unions, namely the National Education Association (NEA) and the American Federation of Teachers (AFT).
AOTA’s initiatives of further aligning IDEA and NCLB were making significant progress, and we will be vigilant to ensure they remain in the bill once Congress returns to the issue. Unfortunately, because of the presidential election in 2008, Congress is expected to hold back on reauthorization until 2009.
Mental Health Parity Update
Mental Health Parity legislation has passed the Senate, reported favorably out of all three House Committees with jurisdiction on the bill, and is awaiting floor action in the House. Variations between the Senate and House bill have made the process somewhat contentious, but AOTA sees both pieces of legislation as improvements over current law.
The House bill sponsored by Representative Patrick Kennedy (D-RI) and Representative Jim Ramstad (R-MN) is more progressive and offers additional protections, whereas both the House and Senate bills extend parity for both mental health conditions and substance abuse disorders. Action on the House bill could come between Thanksgiving and the end of the year. Use the Legislative Action Center at: http://capwiz.com/aota/issues/alert/?alertid=9512946 to learn more and take action.
House Holds Contentious Hearing Related to Medicaid Proposed Rules
AOTA has been actively opposing proposed regulations from CMS that would reduce federal spending for the Medicaid program a total of over $11 billion over 5 years. Most specifically, AOTA opposes the proposal to restrict the reimbursement of services under the rehabilitation option. AOTA is also opposed to the elimination of reimbursement for school-based transportation and administrative claiming costs.
The House Oversight and Government Reform Committee Chairman Henry Waxman (D-CA) recently had a hearing to share discontent with the new regulation and used the committee’s influence to urge CMS to rescind the regulations. The Acting Director of CMS, Dennis Smith, testified in defense of the new regulations but was unable to sway many members of the committee. Congressional action could be necessary if CMS moves forward with the regulations. AOTA will continue to monitor the issue.
FY2008 Labor-HHS-Ed Appropriations Update
On November 15, the House of Representatives failed to override the presidential veto of the FY 2008 Labor–HHS bill. The 277-141 tally fell 2 votes short of the two-thirds majority needed to override the veto. A total of 51 Republicans voted with 226 Democrats for the override; 141 Republicans voted to sustain the veto; and 15 Members did not vote.
President Bush vetoed the FY 2008 Labor–HHS–Education Appropriations bill (H.R. 3043) on November 13. The President had repeatedly vowed to veto the bill because it is nearly $10 billion over his FY 2008 budget request.
The bill was sent to the White House on Thursday, November 8, after the House voted 274 to 141 to approve the conference agreement on the bill. A total of 51 Republicans voted for the conference report; no Democrat voted against it.
The conference agreement on Labor–HHS includes $212 million for Title VII, an increase of $27.3 million (14.8%), as well as report language that covered some other AOTA initiatives.
On November 6, the House passed (269-142) the conference report on H.R. 3043 when it included both the FY 2008 Labor–HHS–Education and Military Construction–Veterans Affairs (MilCon–VA) spending bills. Democratic congressional leaders had combined the two bills to force the Administration to agree to approximately $10 billion in additional funds above the President’s request in the Labor–HHS bill.
The Senate on November 7 failed (47-46) to approve a motion to waive a point of order against the combined package. After the MilCon–VA funding was stripped from the package, the Senate then voted 55-37 to approve the Labor–HHS conference agreement and send it back to the House for final approval.
There is no word at present on how the House and Senate will proceed now that the veto override failed. Stay tuned to the AOTA Legislative Action Center for more details.
Representative Tim Murphy (R-PA) Addresses AOTA/NBCOT Student Conclave
Representative Tim Murphy (R-PA) will addressed approximately 500 students at the first annual National Student Conclave, sponsored by AOTA and the National Board for Certification in Occupational Therapy (NBCOT), in Pittsburgh, PA. Representative Murphy’s district spans parts of Pittsburgh and the surrounding area. He has been a long-time friend of occupational therapy. A psychologist by training, he is Co-Chair of the Congressional Mental Health Caucus and a tireless advocate for people with mental illness. As a psychologist working with children, he is very familiar with the role of occupational therapy in addressing functional and developmental impairments. He addressinged the students on the importance of advocacy and relating advocacy to his work on mental health issues while in Congress. Rep. Murphy is also a member of the influential Energy and Commerce Committee, as well as a co-sponsor of legislation that would repeal the therapy cap.
AOTPAC
2008 will bring Presidential elections with primaries at various times throughout the year, a new AOTPAC Board of Directors, and the 30th anniversary of AOTPAC. Reaching our fund-raising goal for 2007 is imperative to make a difference on critical issues before Congress and begin preparations for the 2008 elections. We are $56,000 short of that goal and need all AOTA members to do their part to help make a difference for occupational therapy. Contributions can be made on the AOTA Web site at www.aota.org/aotpac; by mailing a contribution to AOTPAC, PO Box 31220, Bethesda, MD 20824-1220; or by calling Darlene Dennis at 1-800-SAY-AOTA ext. 2014. If you have not yet contributed, why not take the time now to help further the legislative and political goals for occupational therapy?
Three current AOTPAC Board members will end their terms on December 31, 2007—Karen Jacobs, Region I director; Linda Stephens, Region II director; and Elisa Marks, Region V director. Beginning new terms on January 1, 2008, will be Susan Goszewski for Region I and Monica Robinson for Region II. A director for Region V is expected to be appointed soon. We want to take this opportunity to thank our outgoing board members for their dedication and service and welcome our new board members.
As we prepare for the 30th anniversary of AOTPAC and the 2008 elections, if you know of a candidate for U.S. Senate or U.S. House of Representatives that you would like AOTPAC to consider for support, please contact us at aotpac@aota.org.