Post on 30-May-2018
4/15/2016
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Federal Advocacy Issues Update
Heather Parsons, AOTA Director of Federal
Affairs
John Ray, AOTA Legislative Representative
Advocacy – what’s the environment?
Scanning the
environment,
understanding
trends and
positioning yourself
to for when the
time is right.
Congressional Action
• Reasonably productive Congress:
– Medicare Access and Chip Reauthorization Act
– Elementary and Secondary Education Act
– Sequestration has not taken Effect
– Passed a Transportation Bill • What’s Left?
– Comprehensive Mental Health Bill?
– NIH/FDA rewrite? (Path to Cures, Innovation Act)
– Medicare Fixes (Telehealth, Home Health, other)
Policy Drives Practice
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Federal Advocacy
• Congress and Staff
• Federal Agencies
• Other Associations and Stakeholders
• For:
• Passage of our own legislation;
• Inclusion of occupational therapy in moving legislation;
• Inclusion of occupational therapy in final rules and regulations;
• Funding for initiatives, fight cuts, change an existing policy;
• Simply to educate
•
Unity in Washington
• Triple Aim:
– Care: Improving the Experience of care
– Health: Improving the health of populations
– Cost: Reducing per capita costs of health care
Unity in Washington
• Both parties and the President are behind the using
alternative payment methodologies (APMs):
– accountable care organizations [ACOs],
– primary care medical homes,
– coordinating care,
• How do we define Value?
– $$?
– Client Experience?
– Client Outcomes?
Movement Towards APMs
• The Affordable Care Act (ACA) directed the Centers for
Medicare & Medicaid Services (CMS) to scale up what had
previously been small demonstration projects
• Alternative Payment Models have proliferated in Medicare,
Medicaid, and private insurance.
• Move away from traditional fee-for-service Medicare
– Volume to Value; Quality not Quantity
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CMS Action
• In January, the U.S. Department Health and Human
Services (HHS) began promoting a long-term initiative to
aggressively move payments to quality-based.
• The HHS goal is for 50% of Medicare reimbursement to be
made through APMs by 2018, with all other payment under
Medicare to be tied strictly to quality by 2018.
Long-term goals of Medicare
http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html?DLPage=2&DLSort=0&DLSortDir=descending
• Reducing avoidable hospital readmissions
• Assisting patients with adherence to treatment regimens
• Helping people maintain independence
• Identifying the need for early interventions
• Management of chronic conditions
• Transitioning patients through care continuum
Opportunities for OT – goals of policy makers
AOTA POLICY INITIATIVES
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Medicare Therapy Cap
• Traditionally “patched” each year with fix to Physician Fee
Schedule
• Move to permanently repeal the “SGR” last year
• In April 2015 – Amendment to repeal the cap fell 2 votes
short (received 58 votes!)
• Victories:
– Exceptions process extended through 2017
– “ Targeted Review” of Claims over $3700 instead of
blanket.
Medicare Access to Rehabilitation Services Act
• H.R. 775/S.539
– 223 Co-sponsors in the House (over 50%)
– 32 Co-sponsors in Senate
• Straight repeal of Therapy Cap
• Why won’t it pass?
– $$$$$$$
– Utilization concerns
– Reforms needed
What’s Next for Therapy Cap
• It is not fixed!
– Ben Cardin introduced as amendment and gave a floor
speech last month
• Continue to work with partners for full repeal of cap ahead
of 2017 expiration of exceptions process
• How will MACRA effect therapy cap rewrite?
• How will OT participation in APMs effect therapy cap rewrite
– Changes to payment and delivery structure
– Lower cost?
Home Health
• Need to maximize individuals’ ability to live fuller, more
independent lives
• Clients are, increasingly, receiving care in home and
community settings where occupational therapy plays a
pivotal role.
• Currently occupational therapists cannot conduct initial
home health assessment even when the physician’s order
includes occupational therapy.
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Home Health
• Senators Ben Cardin (D-MD) and Dean Heller (R-NV)
introduced the Medicare Home Health Flexibility Act of
2015 (S.2364)
– Look for introduction in the House soon
• Allows occupational therapists to do “start of care” and
conduct the initial assessment for rehabilitation-only cases
under Medicare.
• This allows the most appropriate skilled rehabilitation
professional to open cases and conduct the initial
assessment.
Home Health
• From 2000-2014, home healthcare spending rose from $8.5b to
$17.9b – 111%
• Studies of home healthcare have shown it to be the most cost
effective post-acute care (PAC) option – 39% of Medicare
episodes, but only 28% of payments in 2012
• Keeping people at home improves outcomes and saves money!
• Recognition of Occupational therapy as a valued member of the
home health care team:
– home safety;
– establishing routines to maximize client compliance with the
plan of care;
– Focus on independence
Telehealth Opportunities
Affordable Care Act
• Increased coverage and emphasis on primary care
Excellence in Mental Health and Veterans Bills
• Telehealth seen as way to solve access problem
Primary Care and Systems Change
• Innovation meets primary care challenges,
– Provider shortages
– Rural needs
• Growing base of evidence demonstrating the efficacy of
technologically mediated occupational therapy.
• DoD and Veteran’s Health Administration permit and encourage
occupational therapy via telehealth
Telehealth
• CONNECT for Health Act
– Demonstration Projects
– Waives restrictions under Medicare
– Allows use in APM’s and in MA
– Collects Data and Measure Quality
• Medicare Telehealth Parity Act
– Phased-in expansion of Medicare telehealth coverage
– Adds Occupational Therapists as telehealth covered providers
– Expands covered telehealth services
• Outpatient therapy, including OT, PT and Speech
– Allows Medicare payments for remote patient monitoring
– Expanded network of originating sites
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Hurdles
• Research and evidence lags behind innovation
– Will the quality of services suffer?
– Will it increase utilization without improving outcomes?
• Cost analysis is huge predictor of policy priorities
and opportunity
• Telehealth must be recognized as adding value and saving
money while improving access
Supporting Rehabilitation Research
• In December 2012, a Blue Ribbon Panel reviewed the state of rehabilitation research at NIH
– Research plan untouched since 1993!
• $300 million in medical rehabilitation research annually
– $70 million of which is supported by the National Center for Medical Rehabilitation Research (NCMRR)
• Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act (S.800, H.R. 1631)
– Developed by DRRC and Senator Mark Kirk
– Enhance Coordination of Rehab Research across NIH; Update research priorities and plan
– Passed out of Senate Committee in Februrary
Chronic Conditions
• Last year, the Senate Finance Committee formed of a bipartisan chronic
care working group
• Tasked with analyzing current law, discussing alternative policy options,
and developing bipartisan legislative solutions to improve care for the
millions of Americans managing chronic illness
• AOTA has submitted 2 rounds of comments
– Evolution of Medicare – is OT ready and positioned to assert our role?
– 14% of Medicare patients have 6 or more chronic conditions and
account for 46% of Medicare spending
– Receiving High Quality of Care in the Home; Advancing Team-Based
Care; Identifying the Chronically Ill Population and Ways to Improve
Quality; Empowering Individuals and Caregivers in Care Delivery
Excellence in Mental Health /Sect. 223
• April 2014 – Passage of Protecting Access to
Medicare Act
• Sect. 223 Establishes the Excellence in Mental
Health Medicaid Pilot Program
• Possible Watershed Moment for Quality,
Community, Mental and Behavioral Health
Services
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Excellence Demonstration Project
• 8 State Medicaid Demonstration project (TBD and expected
to grow)
• Expand access to behavioral health services by
establishing Certified Community Behavioral Health Clinics
(CCBHCs).
• CBHCs would look similar to qualified community health
centers;
• 90% Federal Medicaid spending match
• CBHCs must provide a specific set of intensive mental
health services including integrated care and services
to support independence.
Why Occupational Therapy?
Excellence focuses on:
• Integrated services;
• Helping people achieve independence, health, and
participation in chosen life activities.
Occupational Therapy included in the list of suggested
staffing for the new CCBHC
What’s next
April, 2014: PAMA signed into law
May-August, 2015: States respond to CCBHC Planning Grant RFP
October, 2015: states selected to receive planning grants
October 2015: October 2016--Planning Grant Phase
October, 2016: states apply for Demonstration Grant
What’s Next?
• 24 states have been
awarded grant money to
plan for how they would
implement CCBHCs.
• AOTA is supporting these
24 state associations in
advocating for the
inclusion of OT in each of
the state’s CCBHC plan.
• I
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Occupational Therapy in Mental Health (HR 1761)
• Introduced this Tuesday by Rep. Paul Tonko (D-NY) and
Rep. Mike Kelly (R-PA)
• Would included occupational therapy as a “behavioral and
mental health professionals” under the National Health
Service Corp Scholarship and Loan Repayment Programs
Why the National Health Services Corp?
• Would encourage new occupational therapists to practice in
mental or behavioral health, in high needs areas, through
loan forgiveness.
• NHSC designation would serve as a guideline for states
and other federal programs, when they are defining
qualified mental health professionals.
• Only place in Federal Law where the term “behavioral and
mental health professionals” is specifically defined.
Mental Health Liaison Group letter of
support • The other professions currently eligible for loan forgiveness as mental
and behavioral health professionals either openly support our inclusion
or have agreed to remain silent.
• This support is very rare, but other professions understand the unique
role of OT in helping people with mental illness.
Senate action
• Mental Health Reform Act – S2680
– Makes some changes to SAMHSA including new evidence-based requirements
– State Mental Health block grants – includes new focus on community based and early intervention services
– Strengthens mental health parity requirements
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“Mental Health Reform Act” - OT
• Makes occupational therapy higher education programs
eligible for Behavioral Health Workforce training grants.
1) Would help increase OT workforce going into mental
health
2) Includes OT among other MH providers in program of
national significance.
Senate may vote on this bill next week
“Mental Health Recovery and Reform Act”
• This year, two House bills out of Energy took a broad look at
mental health.
• Tim Murphy (R-PA) “Helping Families in Mental Health Crisis”
• Gene Green (D-TX) “Mental Health Recovery and Reform Act”
• OT in Mental Health was included in the bill “Mental Health
Recovery and Reform Act”.
• Murphy had no opinion on our bill.
• The debate has been quite contentious.
• House may looking to the Senate for a bi-partisan bill in this
Congress
Next Steps
• Ensure language stays in Senate bill.
• Include OT Provisions in any House bill that moves
• Continue to educate Members of Congress, their staff, and
Committees about role of OT in mental health.
• Very positive response to OT’s potential for helping
people achieve their recovery goals and maximize
independence.
Pediatrics and School System
• Education Policy
– Early Ed Inclusion
– Highest Standards for Student’s With Disabilities
– General Education Rewrite
• Autism and Transition to Adulthood
– New focus on “what next”
– Increasing independence for people with disabilities after school
• Habilitation
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General Education
• Every Student Succeeds Act (ESSA) signed into always in
November
• Significantly rewrites No Child Left Behind (NCLB).
• Repeals current accountability system and turns
accountability measures, testing, and support for struggling
schools back over to the states.
AOTA Priorities
• Ensuring recognition of OT in implementing school-wide
initiatives and classroom supports
• New Term: “Specialized Instructional Support Personnel”
• Requires SISPs consultation in developing new plans,
assessments and determining use of funding. Encourages
their use in school wide programs.
AOTA Priorities
• Maintaining rigorous accountability for the performance of
students with disabilities
• Requires schools to report on the performance of specific
subgroups, including students with disabilities.
• Codifies that no more than 1% of students can take an
alternative assessment based on alternative standards
TIME TO TAKE ACTION
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Constituent Power
Grassroots Engagement
• Last year: Over 7,500 people sent over 25,000 messages
to Congress
• That is more people than in any previous year
• Hundreds (maybe thousands) of phone calls to the Hill
No one expected AOTA and the other groups advocating
against the therapy cap to mobilize the way we did.
We made them pay attention.
Constituent Power
Advocacy
Educating people and building relationships (professional staff
and grassroots) so people will know what you are talking
about when you ask them for something.
NOT: THIS:
Why You Should Be the Voice of OT
• Policymakers listen to constituents;
• Policymakers value the input of people in their
community, and the opportunity to learn about
their community;
• You can share personal experiences that get to
the heart of why OT is part of the solution;
• The recipients of your services may not be
able to speak for themselves.
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Save the Date –Hill Day
• September 19, 2016
• Joint AOTA and ASHT Hill Day
Mobile Legislative Action Center
Did you know that you can send a letter to your Members of Congress right from your smart phone? It’s easy:
• 1) Go to www.aota.org/takeaction
• 2) Choose an issue that interests you and select the red “ACT” button
• 3) Enter your zip code and press “Go!”
• 4) Fill in the required forms and hit, “Send Message”
• 5) Review the Message and hit, “Send Message”
Show your Message at the PAC booth and get an “OT Advocate Badge”
Or
Tell us you called your Senators on the Cap to get your badge!
What’s a PAC?
• PAC’s were established by Congress to give like minded citizens a means to raise money to support candidates for office who support their issues
• Contribution Limits
– $5000 donation limit to each candidate
– $5000 limit for donors
• Transparent
– Anyone can see where the money comes from and where it goes
• NOT a Super PAC
– Unlimited donations, contributions, can’t donate directly to candidates, can disguise source of money
Facts on AOTA and AOTPAC
• Face to Face Opportunities Allows OT’s Voice to be Heard and Understood.
• Cultivating New Relationships and Bolstering Our Champions – Ensures a Seat at the Table
• NONE of your AOTA dues can go to support political candidates
• AOTPAC can ONLY accept contributions from AOTA members if this money is to be given to a political candidate
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Comparison to Other PACs
• 2015: – AOTA - $183,563; Goal of $210,000
– ASHA - $209,101
– APTA - $610,721
– First time ASHA has outraised AOTA
• 2016: – $200,000 Goal
– $67,000 Conference Goal
• At $52,000 as of today – don’t let us come up short!
Why do we need a PAC?
• OT instrumental in his return to Congress following stroke, proclaimed his thanks for his OTs in Time magazine
• Author of the Rehabilitation Research Improvement Act
• Cosponsor of the Medicare Access to Rehabilitation Services Act (cap legislation)
• Promoted OT in MH provision for Senate bill.
• 2016 Race – Highly Competitive
Sen. Mark Kirk
How Does It Really Work?
• Money in politics can be a difficult issue to understand and
communicate
• 100’s of other groups and PACs in Healthcare alone
– Attending fundraisers allows us to break through noise
– Meet with staff but how do we get Members attention?
– Fundraisers allows us to make the case directly
– Educate and get our issues to the top of lawmakers
minds – get them to engage their staff on our issues
Discussion
• More about PACs?
• What exactly we do?
• Policy initiatives?
Your Chance to Ask!
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Thank You
• Heather Parsons
– Hparsons@aota.org
• John Ray
– jray@aota.org
• Don’t forget – we work for you!