Federal Legislative Issues Update - June 2011
Summer is just starting but AOTA is already making plans for Capitol Hill Day on Monday September 19, 2011. We need YOU to come to Washington and advocate for OT. The charged political environment is making progress on key issues like the therapy cap an even greater challenge this year so we need all the grassroots support we can muster. Last year roughly 400 AOTA members took the time to come to Hill Day and their voice was loud and clear. This year we want to have AOTA’s largest Capitol Hill Day, bring your colleagues and meet us in Washington on September 19th.
To learn more and to get all the information you need to participate and become the voice of OT please go to AOTA’s Capitol Hill Day page on the Legislative Action Center.
See you in Washington!
AOTA’s federal affairs staff continues to work on several issues critical to the profession including repeal of the Medicare Part B outpatient therapy caps, making occupational therapy an initiating service in Medicare home health, adding OT to the list of Mental Health providers eligible for participation in the National Health Service Corps and elevating the status of OT in the Army Medical Specialist Corps.
While these issues continue to be timely and critical, AOTA is also focused on implementation of the Affordable Care Act (ACA) to identify and address areas critical to the profession and the clients we serve. Federal affairs staff is working in concert with AOTA’s Regulatory and Reimbursement Department, our members, our champions on Capitol Hill, and other key policymakers to build on the successes and momentum AOTA won during the health reform debate.
Over the past several weeks and months AOTA has provided official and unofficial comments to the various Committees of Jurisdiction in the House and Senate related to health reform implementation and also reached out to a range of government and non-governmental organizations with a guiding influence on health reform. In specific AOTA has commented to the Department of Health and Human Services, the Institute of Medicine, the National Association of Insurance Commissioners and the Departments of Labor and Justice among others to ensure the perspective of occupational therapy was heard by decision makers. To Follow AOTA’s ongoing efforts go to AOTA’s Health Reform Hub on the Legislative Action Center and be sure to go to the Health Reform Spotlight on AOTA’s Federal Advocacy page for direct access to many of AOTA’s official comments on regulatory and implementation advances.
Medicare Part B Outpatient Therapy Caps
On April 14th, AOTA achieved a major victory with the introduction of the Medicare Access to Rehabilitation Services Act of 2011 (S.829/H.R.1546) to fully repeal the harmful and arbitrary Medicare Part B outpatient therapy caps, which if implemented would place an $1870 dollar annual cap on occupational therapy services and a separate $1870 cap on physical therapy and speech language pathology services combined.
The sponsors of this legislation Rep. Xavier Becerra (D-CA) and Rep. Jim Gerlach (R-PA) and Senator Benjamin Cardin (D-MD) and Senator Susan Collins (R-ME) were joined by several bi-partisan original cosponsors, including Representative Andre Carson (D-IN) and Senators Inouye (D-HI), Blunt (R-MO), Leahy (D-VT), Johnson (D-SD), Franken (D-MN), Graham (R-SC), and Reed (D-RI), signaling their strong support for the issue, the profession of occupational therapy, and the consumers you serve.
While this is a major step towards repealing the cap, there is a great deal of work to be done. If Congress does not take additional action before December 31, 2011, the caps will be implemented and an estimated 640, 000 beneficiaries, roughly the size of a Congressional district, will be adversely affected.
Now is the time to advocate for your profession and the consumers you serve, visit AOTA’s Legislative Action Center today to urge your members of Congress to support repeal of the Medicare Part B outpatient therapy cap!
AOTA’s Mental Health and National Health Service Corps Initiative (NHSC)
In an effort to move forward with AOTA’s mental health agenda and to address workforce issues for the profession of occupational therapy and mental health practice, AOTA has begun work on federal legislation to make occupational therapists eligible to participate in the National Health Service Corps as federally qualified mental health professionals. AOTA is actively seeking bi-partisan introduction of the legislation in both the House and Senate.
The National Health Service Corps is a federal program to support the education, training and employment of health care practitioners in an effort to increase access to care in rural and medically underserved areas. Once eligible, occupational therapists would be able to compete for employment and loan forgiveness in participating facilities. A five year commitment is necessary within the NHSC and then the occupational therapists would be eligible for federal loan forgiveness.
The initiative has the added important benefit of raising the profile of occupational therapy in mental health practice, and successful inclusion of occupational therapy in federal mental health law would increase our effectiveness in advocating for an expanded role in mental health for occupational therapy practitioners under state law and scope of practice acts.
The NHSC initiative is only related to occupational therapists because of NHSC requirements to support graduate education. AOTA’s over-arching mental health initiative, however, is inclusive of expanding mental health roles for occupational therapists and occupational therapy assistants alike.
To learn more about the NHSC go to: http://nhsc.hrsa.gov/
Army Medical Specialist Corps (AMSC)
Occupational therapy practitioners, physical therapy practitioners, dieticians and physician assistants comprise the Army’s Medical Specialist Corps. The Specialist Corps is led by the Chief Officer of the Corp that is chosen from one of the represented professions. The Chief of the Specialist Corps is Colonel while every other Medical Corp in the Army including the Army Veterinary Corps is led by a General as their Chief Officer. Beyond the issue of fairness and equity for such important professions within the Specialist Corps there is the very real problem of rank given the hierarchical nature of the military.
AOTA is working in coalition with the American Physical Therapy Association, the American Dietetic Association and the American Academy of Physician Assistants to legislatively elevate the Chief of the Specialist Corps to the rank of Brigadier (1 Star) General. In this effort, AOTA is working to support legislation (S. 786) introduced by Senator Tim Johnson (D-SD) that would achieve this goal.
While AOTA is confident in the importance of elevating the Chief, the political environment in Washington is making progress difficult. The Army has been slotted to reduce the General Officers by more than 2 dozen over the next few years. “Even though we are swimming against the tide, there is no doubt of the necessity of elevating the Chief, especially when we are seeing the need for so much rehabilitation of our soldiers because of injuries received in Iraq and Afghanistan.” said, Tim Nanof, AOTA’s Director of Federal Affairs. “The Chief of the Specialist Corps must be a general Officer to ensure the rehabilitation and reintegration needs of our soldiers are given full voice.”
As the legislative session progresses AOTA will have Action Alerts on AOTA’s Legislative Action Center so that you can help move this legislation forward during the current 112th Congress. To learn more about the Specialist Corps go to: https://amsc.amedd.army.mil/
Medicare Home Health Flexibility Act
While the Medicare Home Health Flexibility Act has yet to be introduced in the 112th Congress, AOTA has been aggressively working to secure strong bi-partisan support prior to introduction. Our efforts have secured strong champions in both houses of Congress as Senator Tim Johnson (D-SD), and Representatives Charles Boustany (R-LA) and John Lewis (D-GA) have agreed to introduce and take the lead on this critical issue.
This legislation will go a long way to curing inefficiencies in Medicare home health while also elevating the status of occupational therapy. We urge you to visit AOTA’s Legislative Action Center for updates on this critical issue and to contact your members of Congress to urge their support for making occupational therapy an initiating service in Medicare home health
Medicare Physician Fee Schedule (SGR)
At the end of 2011 the Medicare Physician Fee Schedule, on which outpatient occupational therapy is paid under the Medicare program, is scheduled to receive a 29.5% cut for 2012. Absent Congressional action, this cut will be in effect on January 1, 2012 and impact all Medicare providers paid on the fee schedule. (This cut is in addition to and unrelated to the therapy cap and the multiple procedure payment reduction policy.)
AOTA is working in strong coalition with other health care provider and consumer advocacy organizations, including the American Medical Association and the Consortium for Citizens with Disabilities (CCD), to oppose these cuts. In addition, AOTA is actively working to identify alternative payment options for therapy services that might help address payment and utilization concerns specifically related to therapy services.
While there is broad-based bi-partisan support for Congressional action to forestall these severe cuts, the challenge is the cost of finding off-sets for the increased spending that would be caused by avoiding the payment cut on January 1. The cost of delaying the cuts for just 2012 alone is expected to exceed $30 billion.
The House Energy and Commerce Committee held a hearing on May 5th to address the fee schedule and solicited comments from AOTA regarding means of addressing the fee schedule problem. AOTA highlighted the importance of access to quality health care providers for Medicare beneficiaries and noted that a 30% cut to providers could negatively impact access to all Medicare providers including occupational therapy practitioners. In addition, AOTA noted that at the end of 2010 Congress legislated a permanent cut to therapy service reimbursement through the application of the multiple procedure payment reduction policy (MPPR) that was used to pay for a one month delay in the fee schedule cut scheduled for 2011. That $1 billion cut to therapy services over 10 years helped ensure the larger cut for 2011 was not applied and represented a significant contribution from the therapy community to the solvency of the Medicare fee schedule.
AOTA will continue to monitor this critical issue and include it as a priority for action as the year progresses and Congress takes up Medicare issues in the Fall. Here is an Informative article from the Hill Newspaper discussing the fee schedule problem.
Frontline Health Care Providers
AOTA continues to work to address workforce shortages of qualified occupational therapy providers and is working with Representative Bruce Braley (D-IA) who has introduced the Access to Frontline Health Act (H.R.531). This bill would establish and carry out a Frontline Providers Loan Repayment Program to provide loan repayments in exchange for a health professional, including occupational therapy practitioners, providing frontline care services for two years in a designated scarcity area.
This legislation will help address shortages of qualified occupational therapy practitioners and provide clients with access to necessary and critical services. Federal Affairs staff continues to work to build strong bi-partisan support for H.R. 531 specifically and the need to address health care workforce shortages in general. We urge you to visit AOTA’s Legislative Action Center to advocate with your members of Congress on this important issue.
Autism Spectrum Disorders (ASD) and their treatment continue to be a hot topic on Capitol Hill with several bills being introduced to address this critical issue. Federal Affairs staff is working actively to identify and address opportunities to protect and advance the interests of the profession and individuals coping with autism spectrum disorders and to educate members of Congress and their staffs about the critical role of occupational therapy in the treatment of ASD.
Current indications are that the Combating Autism Reauthorization Act (S.1094/H.R2005) introduced by Senator Robert Menendez and Representative Christopher Smith (R-NJ) to reauthorize legislation from 2006 will likely serve as the vehicle for addressing the issue during the 112th Congress, with portions of other bills being considered as possible amendment language during the reauthorization process.
While the Combating Autism Reauthorization Act, will likely be the vehicle for this issue, AOTA has been actively meeting with the sponsors and cosponsors of other autism legislation including S. 850, the Autism Services and Workforce Acceleration Act, introduced by Senator Dick Durbin (D-IL), to insure that occupational therapy is appropriately included in any initiative dealing with the treatment of ASD.
Elementary and Secondary Education Act Reauthorization (ESEA/NCLB)
ESEA, the original and once again current name for the No Child Left Behind Act, is the federal law governing general public education. The law was last reauthorized during the Bush administration and is being considered for reauthorization over the next year or so. Some activity has begun in the House under the leadership of Education and Workforce Committee Chairman John Kline (R-MN) and Chairman Duncan Hunter of the Subcommittee on Early Childhood, Elementary, and Secondary Education. The controversial proposal seeks to streamline federal funding by eliminating up to 43 programs and folding that specified money into general federal education spending. Groups interested in the specific programs that will lose their targeted funding are raising significant political concerns about potential negative outcomes.
AOTA is specifically interested in how the proposal. If approved, would impact early intervening funding and services that drive models of school wide support such as Response to Intervention (RtI) and Positive Behavioral Interventions and Supports (PBIS). The proposal and overall action on ESEA are not expected to progress quickly because of the politics involved with the Republicans controlling the House and Democrats being the majority in the Senate. AOTA will monitor these issues and continue to provide comments and feedback to the Committees’ involved in both chambers. To guide our advocacy efforts AOTA staff worked collaboratively with the EI-SS-SIS to develop AOTA’S Principles for Reauthorization of ESEA.
Institute of Medicine (IOM) - Meeting on Cognitive Rehabilitation Therapy
The Institute of Medicine is a part of the National Academy of Sciences, an independent non-governmental organization that provides guidance and advice to decision makers across the country. AOTA monitors and participates in various meetings with the IOM as well as other similar bodies that have influence over policy decisions related to health care and education issues. Recently AOTA attended and provided comments to the IOM regarding the role of occupational therapy in cognitive rehabilitation. As a result of the interaction, an effort is underway to create a series of advocacy documents that will highlight occupational therapy’s role in addressing all too common health care conditions. The documents will be modeled after AOTA’s Health Reform advocacy tool titled, OT: Part of the Health Care Solution. Areas addressed will focus on cognitive rehabilitation in various settings and with differing populations such as older adults, veterans and wounded warriors. Additional documents will focus on physical rehabilitation and on mental health.
Institute of Medicine (IOM) - Meeting on the Allied Health Workforce
AOTA recently participated in an IOM workshop on the Allied Health Workforce and Services to represent the interests of occupational therapy related to training, education, employment and general workforce trends. Former AOTA Executive Board Member and Research Advisory Panel Chair Dr. Joan Rogers PhD, OTR/L, FAOTA presented during the workshop and highlighted the unique role and contributions of occupational therapy as well as the workforce needs faced by our profession. Dr. Rogers’ presentation was well received and her typical clear and concise presentation of professional research helped raise the profile of occupational therapy for the attendees and those following the IOM’s workshop. Additional information is available in the AOTA web article related to the IOM Allied Health Workforce and Services Workshop.
Department of Labor Report on benefit Coverage under Employer Based Plans
AOTA was disappointed in the inadequate report to the Secretary of the Department of Health and Human Services (HHS) delivered by the Department of Labor (DoL). As part of the Affordable Care Act (ACA) (Public Law 111-148) the Department of Labor was directed to conduct a survey of employer-based plans to determine a basic benchmark of what those plans typically covered, but there was no appropriation of additional funding provided to the DoL to carry out the study. As a result the DoL used an existing voluntary employer-focused initiative to survey human resources departments to determine what benefits were being covered. This inadequate plan was also hampered by a lack of an appropriate and incomplete list of search terms that did not specifically include occupational therapy or even rehabilitation or habilitation. A brief section on physical therapy was included as a secondary review, as they were left out as well, and that section notes that physical therapy, occupational therapy and speech therapy are often provided under a common benefit category of varying names. AOTA believes that the survey was an important directive of the ACA and its completion by using an existing and inadequate process is unacceptable and fails to provide the Secretary of HHS the important information she needs to have regarding the true extent of current employer-based coverage.
AOTA is in the process of filing official comments raising concerns about the report and those comments will be available on AOTA’s Health Reform Spotlight page once submitted. In addition, AOTA has met directly with the DoL, HHS and other stakeholders, including the Institute of Medicine and the National Association of Insurance Commissioners, to share our concerns and to advocate for occupational therapy. Additional opportunities for official comment remain available, and AOTA will be taking advantage of all venues to ensure the voice of occupational therapy is heard by the key stakeholders and decision makers.
Friends of HRSA
The current fiscal environment is forcing many legislators to look for any possible savings in the FY 2012 budget to help address current deficits. AOTA is specifically concerned with the possible implications these cost cutting efforts might have on funding for critical institutes and programs, including the Health Resources and Services Administration (HRSA), the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable.
One of HRSA’s primary goals is to support education and training of health care providers including occupational therapists, and AOTA believes that adequate funding for these programs will be critical and should not be subject to harmful budget cuts.
To support these efforts AOTA is an active member of the Friends of HRSA coalition which has been actively working to protect funding for HRSA in the FY 2012 budget.
Please visit the Friends of HRSA Web site to learn more about the coalition and its current activities.
AOTA continues to work in concert with the Patient Access to Responsible Care Coalition (PARCA) to broadly monitor and address implementation of the Affordable Care Act (ACA) (P.L. 111-148), specifically from a non- MD health care perspective.
Federal Affairs staff is working with the Patient Access to Responsible Care Alliance (PARCA) on several key issues critical to non-MD health care providers on several key issues surrounding the implementation of the ACA, including the make up of essential benefits package, the structure of Accountable Care Organizations (ACO) and payment reform.
Visit the PARCA Web site to learn more about the alliance and its current activities.
The cost cutting environment on Capitol Hill is causing concerns in the disability and rehabilitation research community that important institutes, including the National Institute of Health and specifically disability and rehabilitation research, may be targeted for cuts in the FY 2012 budget. AOTA is fully committed to protecting these critical funds and will be working to insure critical programs and research are not on the chopping block.
AOTA is an active member of the Disability and Rehabilitation Research Coalition (DRRC), a coalition of national non-profit organizations committed to improving the state of the science of rehabilitation and disability research. The DRRC is committed to protecting funding levels in the FY 2012 budget as well as other issues critical to the disability and rehabilitation research community, including the priorities of the Patient Centered Outcomes Research Institute (PCORI), specifically regarding comparative effectiveness research authorized in the ACA; and the elevation of the National Center for Medical Rehabilitation Research (NCMRR) within the National Institutes of Health.
Visit the DRRC Web site to learn more about the coalition and its activities.
Traumatic Brain Injury (TBI)
Traumatic Brain Injury (TBI) is a signature injury of the conflicts in Iraq and Afghanistan and the prevalence of these injuries has gained national prominence and alerted Congressional leaders to the importance of providing our returning soldiers with the best possible care. AOTA has been actively meeting with members of Congress and their staffs to educate them about the critical role of occupational therapy in returning individuals with TBI to a productive, meaningful life, both with our wounded warriors and other individuals coping with these injuries.
Several bills have been introduced relating to TBI, including the Veterans’ Traumatic Brain Injury Rehabilitative Services’ Improvement Act of 2011 (S.957) and the Veterans' Traumatic Brain Injury Rehabilitative Services' Improvements Act of 2011 (H.R.1855).. AOTA is actively meeting with the sponsors of these and other TBI related bills to educate members and their staffs about the important role of occupational therapy in treating these conditions and helping our wounded warriors maximize their functional reintegration into their lives, homes, and communities.
Veterans Mental Health
AOTA is firmly committed to protecting and advancing the role of occupational therapists working with our wounded men and women returning from the conflicts in Afghanistan and Iraq, specifically occupational therapy’s role working with soldiers coping with post-traumatic stress disorder (PTSD) and other mental health issues.
Federal Affairs staff attended a hearing held by the House Committee on Veterans Affairs entitled, Mental Health: Bridging the Gap Between Care and Compensation for Veterans, and is actively working with members of the Veterans Affairs Committee to educate them about occupational therapy’s role in helping soldiers coping with PTSD and other mental health issues to maximize their functional performance and fully reintegrate into their lives at home and in their communities.
AOTA has been working closely with Congressman Jerry McNerney (D-CA) to highlight occupational therapy’s role working with our soldiers during the Committee’s June 13th hearing, and will continue to work with Members and their staffs to make sure our wounded men and women have access to critical occupational therapy services.
AOTA recognizes the provision of telehealth services as an emerging practice area for the profession of occupational therapy and is working to identify and address initiatives that would affect occupational therapy’s role in telehealth.
Representative Glenn Thompson introduced the Service Members' Telemedicine and E-Health Portability Act of 2011 (H.R. 1832), which would allow for the provision of occupational therapy to veterans across state lines if the client is located in a federal facility at the time of treatment. AOTA will be meeting with members of both the House and Senate to educate them about occupational therapy’s role in the effective provision of telehealth services.
AOTA continues to work with the American Telemedicine’s licensure portability working group, which includes representatives from both the American Physical Therapy Association (APTA) and the American Speech Language Hearing Association (ASHA). The over-arching goal of the group is to develop strategies to address licensure portability issues that would be a major obstacle to the utilization of telehealth services, including occupational therapy services, across state lines.
American Occupational Therapy Political Action Committee (AOTPAC)
The AOTPAC Board of Directors is seeking AOTA members to serve on the board for the Region III area. Full details can be found on the AOTA Web site under www.aota.org/aotpac. The deadline for application is July 29, 2011. Region III includes: Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, Ohio and Tennessee. Questions can be addressed to email@example.com.
At the end of May 2011, AOTPAC has received $80,000 toward its $225,000 goal. All AOTA members are encouraged to contribute and all levels of contributions are appreciated. Achieving the fundraising goal for 2011 is important as the 2012 elections approach. The political climate remains volatile and members of Congress must hear the voice of occupational therapy. AOTPAC supports the AOTA legislative agenda by helping to elect candidates who understand and support the occupational therapy profession and the clients served.
Candidates have begun their campaigns and are approaching AOTPAC for contributions. The AOTPAC Board carefully considers all candidates brought forward, using established criteria. Amy Lamb, AOTPAC Chair and Region IV Director says, “I maintain it is important to have friends on both sides of the aisle as the balance of power can shift at anytime.” AOTPAC is bipartisan and supports candidates from any party who understand and support occupational therapy concerns. Recommendations of candidates for federal office are welcomed from AOTA members. Send an e-mail to firstname.lastname@example.org with any recommendation and include the reason this candidate would be good for occupational therapy.