Federal Legislative Issues Update - Mar 2008
Washington Highlights
The House and Senate chambers took varying lengths of recess in April. While members of Congress were out of town, AOTA staff remained busy preparing for their return by working with their individual and committee staff on issues important to the profession. Members of Congress are schedule to return to Washington, D.C., on March 31, for an anticipated busy schedule until the Memorial Day recess on May 26. At the top of an aggressive agenda is Medicare legislation that lawmakers in each chamber are committed to pass prior to June 30,at which time many of the provisions in December’s Medicare, Medicaid, and SCHIP Extension Act of 2007 will expire. Read more about this and other issues and activities from March below.
Watch the AOTA Web site and AOTA Legislative Action Center for additional information on federal issues as they are made available. Read below about Hill Days scheduled for May and September to highlight AOTA’s policy agenda.
Medicare Legislation on Senate Schedule: Therapy Caps and Fee Schedule Need Grassroots!
Senate staff has hinted to AOTA staff that the chamber will consider Medicare legislation in the coming weeks and months. Members of Congress in the House of Representatives have indicated that the Children’s Health and Medicare Protection Act of 2007 (CHAMP Act) that passed in the House in July of 2007 will be their position on Medicare provisions scheduled to be addressed prior to the June 30 expiration of many of the provisions included in the Medicare, Medicaid, and SCHIP Act of 2007 that was passed by both chambers in December of 2007. This puts the Senate in the position to begin discussions on what will be included in the next Medicare bill.
The short-term fixes in the December bill must be addressed prior to June 30, 2008, or many of the provisions will be implemented, including an approximate 10% cut to the Medicare Physician Fee Schedule (MPFS) which reimburses for Medicare Part B outpatient therapy services, and the implementation of the therapy caps at $1,800.00 on July 1, 2008.
These harmful provisions to providers and beneficiaries need grassroots action. Previous legislative fixes were a result of steadfast grassroots advocacy by AOTA members and other therapists. Contact your members of Congress today to urge their support to include an 18-month extension of the therapy cap exceptions process and an 18 month update to the MPFS.
Go to the Legislative Action Center to send your members of Congress a form letter urging their support to avoid the pending therapy cap implementation. Form letters can be personalized to tailor your message specific to your interest. Connect with your members today!
2008 Hill Days!
AOTA has scheduled two Hill Days in 2008 to provide occupational therapists, occupational therapy assistants, and students of occupational therapy the opportunity to connect with their elected officials on issues important to the occupational therapy profession.
Virtual Hill Day – May 20, 2008
With pending Medicare legislation under discussion, AOTA has planned for a Virtual Hill Day on Tuesday, May 20, in order to highlight issues of interest in the Medicare package. More details will be made available shortly, but plan now to be part of this massive push to urge members of Congress to include 18-month extensions on the therapy cap exceptions process and the Medicare Physician Fee Schedule update.
Participants will be calling, sending emails, letters and faxes to Capitol Hill to express the need to pass legislation NOW to stop the therapy caps from returning without exceptions and to prevent the 10% cut in the MPFS.
Plan now, and recruit patients and colleagues to join. Forward information on this virtual Hill Day to patients and colleagues who would be interested in advocating for action on the therapy cap. Monitor the AOTA Web site and Legislative Action Center for additional information in the coming weeks.
Annual Capitol Hill Day
AOTA has scheduled the 2008 AOTA Capitol Hill Day for Monday, September 22. Block your schedule off and think about needed preparation now. AOTA will begin asking for RSVPs by July. Keep your eyes and ears out for further information as plans come together. Please contact AOTA’s Federal Affairs office with any questions or comments at fad@aota.org.
Medicare Home Health Bill for OT Set for Introduction
AOTA staff has secured a commitment from Representative John Lewis (D-GA), a senior member of the powerful House Ways and Means Committee, to introduce a bill to move forward the role of occupational therapy in home health.
If passed, the Medicare Home Health Flexibility Act will allow occupational therapy therapists? to open cases! Though the bill does limit opening to certain rehabilitation cases, this is a significant step forward. The bill has the support of the National Association of Home Care and Hospice, which has been invaluable.
The pending introduction of the bill is a result of nearly a year’s work with Representative Lewis’ office, by AOTA staff and an AOTA member from the Congressman’s district—a true advocacy success!
Past AOTA President Carolyn Baum to Testify Before House Committee
Carolyn Baum, PhD, OTR/L, FAOTA, is scheduled to testify before the House of Representatives Veterans Affairs Committee’s Subcommittee on Health promoting the role of occupational therapy in meeting the needs of veterans with post traumatic stress disorder. The hearing, entitled “Post Traumatic Stress Disorder: Moving Ahead Toward Recovery,” is scheduled for April 1, at 10:00 a.m. in the Cannon House Office Building in Washington, D.C.
Check back to the AOTA Legislative Action Center for details after the hearing.
AOTA Conference Sessions from the Public Affairs Division
Federal Affairs Department
Medicare on the Hill
SC206 – Conv Ctr 202ABC-- Friday, Apr 11, 2008, 8:00 a.m. - 9:30 a.m.
Congress considers legislation that changes Medicare benefits, payments, access, and coverage requirements. These issues affect the day to day practice of occupational therapy. This course will examine recent and upcoming Medicare legislation that could impact occupational therapy.
Emerging Practice Areas and Other Issues
SC308 – Hyatt Shoreline – Saturday, Apr 12, 2008, 9:00 a.m. -10:30 a.m.
Congress considers legislation that changes Medicare benefits, payments, access, and coverage requirements. These issues affect the day to day practice of occupational therapy. This course will examine recent and upcoming Medicare legislation that could impact occupational therapy.
Regulatory and Reimbursement Policy Department
Medicare Update: Hot Topics in Medicare Payment for OT
WS310 – Renaissance Ballroom I-III – Saturday, Apr 12, 2008, 2:00 p.m. - 5:00 p.m.
Staff will highlight the hot topics at Centers for Medicare and Medicaid Services over the past year and provide tips on how attendees can take action on AOTA advocacy initiatives to 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.
Medicare Basics: Welcome to the World of Medicare
SC242 – Conv Ctr 201AB – Friday, Apr 11, 2008, 3:30 p.m. - 5:00 p.m.
Participant objectives include being able to (1) understand the Part A and Part B Medicare program regulatory processes and payment systems; (2) identify the required enrollment tools and procedures to assist practitioners with program participation; and (3) understand the documentation requirements required for OT evaluation and treatment and where to find them.
State Affairs Department
Tools and Strategies to Understand and Advocate for the Occupational Therapy Scope of Practice
SC226 – Conv Ctr 201AB – Friday, Apr 11, 2008, 1:30 p.m. - 3:00 p.m.
The 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.
AOTPAC
If you are attending the AOTA Conference in Long Beach, it is not too late to provide us with your photos with Members of Congress (past and present) to showcase during the AOTPAC Night event in our "gallery of OT stars." Please send your photo to ddennis@aota.org no later than April 3, 2008, or bring it with you to Conference and deliver it to Darlene Dennis at the AOTPAC Booth in the Conference registration area. Be sure to identify those in the photo.
As the 2008 election year continues, the AOTPAC Board of Directors encourages you to vote in any upcoming primary and the general election. If you have not yet registered to vote, take the opportunity to do so today. You can get information from the AOTA Legislative Action Center by visiting the 'Election' tab, finding your state, and following the directions.
Recreational Therapy Legislation Update
As reported in the February issue of the Federal Legislative Issues Update, Representatives Ellen Tauscher (D-CA) and Phil English (R-PA) recently introduced the Ensuring Medicare Access to Recreational Therapy Act of 2007 (H.R 4248). The legislation directs the Centers for Medicare and Medicaid Services to clarify current coverage and payment policy by issuing notification, through a notice of proposed rulemaking or in the Medicare Benefits Policy Manual, that recreational therapy is a covered inpatient service in inpatient rehabilitation facilities, inpatient psychiatric facilities, and skilled nursing facilities, and that the cost of providing such services has already been built into the prospective payment systems for these inpatient settings.
AOTA staff raised concerns with the legislation in the “findings” section that describes the type of services that recreational therapists provide. The bill refers to recreational therapists as professionals who provide a critical health care service that “restores, remediates, and rehabilitates functional capacity for persons with injuries, chronic illnesses, and disabilities.”
AOTA worked with the sponsors of the legislation to provide language that clearly defines the scope of therapeutic recreation as separate from that of occupational therapy by including “through recreation and leisure activities” at the end of the aforementioned findings language. The sponsors agreed to consider the changes if the findings language is included in any legislation moving forward in 2008, and also to reconsider and consult with AOTA prior to the reintroduction of the legislation in the 111th Congress.
Continue to watch the AOTA Legislative Action Center for any developments to the Ensuring Medicare Access to Recreational Therapy Act of 2007.
Medicare Trustees Report Released
The Medicare Program is the second-largest social insurance program in the U.S., with 44.1 million beneficiaries and total expenditures of $432 billion in 2007. The Board of Trustees for Medicare report annually to the Congress on the financial operations and actuarial status of the program. The report on Medicare Part B is slightly flawed, however, because the Trustees Report projections show Part B costs increasing rapidly over the next 10 years, but those projections are constrained by the requirement that the Trustees base their work on current law. The sustainable growth rate formula for physician payment calls for payment cuts that, if prevented by Congress, would add 10 to 20 percent to Part B spending over the next 75 years. Read below some highlights of the report:
- Hospital Insurance Trust Fund (Part A): The Medicare Trustees report that the HI Trust Fund is not adequately financed over the next ten years. The Trust Fund’s assets are projected to decrease from $326 billion to $96 billion between 2008 and 2017, “far less” than the recommended minimum level of one year’s expenditures. The Trust Fund’s exhaustion date remains in 2019, though it arrives earlier in 2019 than last year’s report. The change is due to slightly lower projected payroll tax income and slightly higher projected benefits. HI costs will consume 4.8% of gross domestic product (GDP) in 2082, up from 1.5% currently.
- Supplemental Medical Insurance Trust Fund (Parts B and D): The SMI Trust Fund is adequately financed over the next ten years and beyond because premium and general revenue income are reset each year to match expected costs.
- Part B costs growing rapidly: Part B costs averaged 9.6% annual growth over the last five years. Part B outlays were 1.3%of GDP in 2007 and will reach 4.1% by 2082. Current law projects 6.2% annual growth for the next ten years, but that growth rate is constrained by unrealistic assumptions about physician payment reductions. If Congress continues to override those scheduled fee reductions, Part B’s annual growth rate will average roughly 8%.
- 45% “trigger”: The Medicare Trustees issued a third consecutive determination of projected “excess general revenue Medicare funding” in the 2008 report, triggering the statutory “Medicare funding warning.” The next President will be required to submit proposed legislation to respond to this warning next year, as President Bush did in February 2008.
- Trustees call for prompt action: The Trustees Report argues, “These projections demonstrate the need for timely and effective action to address Medicare’s financial challenges…the sooner the solutions are enacted, the more flexible and gradual they can be.”
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 at fad@aota.org; PO Box 31220, Bethesda, MD 20824-1220; 800-729-2682, or Fax: 301-652-7711.