American Association for

Respiratory CarePACT MEETING

Marriott DFW Airport North

Sunday, March 30, 2008Miriam O’Day (oday@aarc.org)

Legislative Affairs

2008 is an Election Year

One third of the Senate is up for election

The entire House of representatives is up for election

Members of Congress will be tuned in to the voters - now is the opportunity to hold them accountable

AARC 2008 Legislative Agenda

Medicare Respiratory Therapy InitiativeHR 3968 S 2704

Pulmonary and Cardiac RehabilitationS 329 HR 552

CDC COPD Program and Action PlanAppropriations Request with Professional Judgment

How things get done in Washington

CommitteesCommittees of jurisdiction over Medicare issues

House Ways and MeansHouse Energy and CommerceSenate Finance Committee

State DelegationsView them as a whole

PACT - Making the Personal ConnectionConsistency - Relationships

How things get done in Washington

CommitteesCommittees of jurisdiction over Medicare issues

House Ways and MeansHouse Energy and CommerceSenate Finance Committee

State DelegationsView them as a whole

Congressional COPD CaucusFighting the 4th Leading Cause of Death

Important Legislative Agenda IncludesAirline OxygenReimbursement for Pulmonary

RehabIncreasing Data CollectionCOPD CDC Chronic Disease

ProgramLanguageColloquy

Pulmonary and Cardiac RehabilitationHR 552 and S 329

CMS - No National Coverage Determination - “Lacks Legislative Authority”After PACT 12 Additional Co-Sponsors for the House - 179After PACT 1 new Senate Co-Sponsor - 41Medicare Provisions Expire June 30From Senate to HouseHired Democratic “Closer”Elmendorf Strategies - AARC; AACVPR; NAMDARC; ATS; COPD Foundation

What will happen with Medicare?Will Pulmonary Rehab be included?

How will it be paid for?How large will the package be?In play…Competitive Bidding released last Thursday

Oxygen down from $200 @ ~ 150Oxygen Cap Reduction from 36 -18 or 1318 months?

The larger the package the greater the chances of other provisions included

Oxygen Reimbursement (Cap)DRA reduced coverageCeded ownership to Medicare Beneficiary after 36 Months (January 2006)Modality Specific ReimbursementAdministration Budget Recommends Reduction to 18 monthsCongressional Discussions about13 months (Farm Bill)

Oxygen Reimbursement (Cap)US COPD Coalition

Letter to Senate Finance Committee

“First Do No Harm”Recommends

Reviewing Patient Safety DataAccess to Appropriate

EquipmentGAO Study

Stimulate Public Health InfrastructureCDC COPD Program

Appropriations Language Amendment

Professional JudgmentCoalition - ALA; ATS; COPD

FoundationAlpha-1 CDC Language

Development of COPD Program Must Consider Genetic

Component

Partnership - Healthcare ProfessionalsExtending BenefitsAccess to Respiratory Therapists for Medicare Beneficiaries UnderPart B

HR 3968Senate CompanionS 2704

Medicare Respiratory Therapy Initiative

Legislators must be educated about the profession and the impact of pulmonary disease on individuals

Legislators cannot support legislation unless they know it exists

Legislators need to know about constituent support

Always make it personal

Medicare Respiratory Therapy Initiative

House BillHR 3968Primary Sponsor - Mike Ross (D-AR)

Senate BillS 2704Primary Sponsors

Blanche Lincoln (D-AR)Mike Crapo (R-ID)

Medicare Respiratory Therapy Initiative

Amends Medicare law to permit RRTs with a bachelor degree to work under general physician supervision

These RTs could provide their scope of practice without the physician having to be on site under Medicare Part B

Medicare Respiratory Therapy Initiative

If enacted qualified RRT with a bachelors degree will be able to expand their opportunities to provide services for the Medicare patient outside of the institutional setting

Bachelors degree does not have to be in respiratory therapy

Medicare Respiratory Therapy Initiative

ImpactPhysician offices:

Patients have greater access to respiratory therapistsPhysician does not have to be present

Smoking cessationDisease ManagementAsthma Management Diabetes Inhaled InsulinMDI/DPI device selection and patient medication

education

Medicare Respiratory Therapy Initiative

The Future of Respiratory Therapy:Current law does not permit independent practice or billingThis initiative does not permit independent practice or billing85% of Physician Fee ScheduleDetails of Implementation will be negotiated with CMS in a regulatory process

Medicare Respiratory Therapy Initiative

The Future of Respiratory Therapy:Allows data collection to evaluate

outcomes and substantiate the value of respiratory therapists in the entire array of non-hospital sites

This type of outcome data will enhance the entire profession of respiratory therapy and all respiratory therapists

Medicare Respiratory Therapy Initiative

White PaperScope of Practice and State Licensure

Cost EstimateReliable Outside Source

FAQOne Page for Congressional Staff

Allied Health ChartStatute and Credentials

Dear Colleague Letters

Medicare Respiratory Therapy Initiative

435 PlanThis is an RT Bill - Congress expects to hear from RT’sWhat is good for the profession is good for patientsUse this tool to develop the patient community - they needyou - we need them - Create a TEAM

Medicare Respiratory Therapy Initiative

White PaperScope of Practice and State Licensure

Amendments to Medicare Statute always raise questions about “turf”Will RT’s be expanding their scope of practice?Who’s territory are we stepping into?White paper addresses these questions

Medicare Respiratory Therapy Initiative

Cost EstimateCongressional Budget Office (CBO)evaluates federal governments cost forall legislation that is under seriousconsideration

Many organizations obtain an “outside” score to estimate this cost

Medicare Respiratory Therapy Initiative

Cost EstimateUnited BioSource Corporation

Don Muse and Associates$5 million over 5 yearsCost is low due to “self-limiting” benefit - credentialsSources of Data

•Price and Utilization Assumptions CMS 2005 Physician/Supplier Procedure Summary Master File•Demographic Data from the AARC 2005 National Manpower Survey

Medicare Respiratory Therapy Initiative

FAQOne Page for Congressional Staff

Addresses LawCredentialingInitiativeSubstantiates Need

Medicare Respiratory Therapy Initiative

Allied Health ChartStatute and CredentialsSites all areas of statute that recognizes non-physician providers Sites all credentialsStates that allied health professionals require advanced credentials in Part B

Medicare Respiratory Therapy Initiative

Dear Colleague LetterFrom Members of Congress to their Colleagues“Official” endorsement of RT’s and the InitiativeBoth House and Senate Letters are “FRESH” - March 2008

Medicare Respiratory Therapy Initiative

Supporting OrganizationsAmerican Thoracic Society (ATS)American College of Chest Physicians (ACCP)AARC Board of Medical Advisors (BOMA)

BOMA is comprised of representative organizations

No Known Opposition

Medicare Respiratory Therapy Initiative

Following PACT Meeting130/275 meetings indicated support

Medicare Respiratory Therapy Initiative

COPD - is being brandedFourth Leading Cause of DeathOnly One in Top Five on the Rise12 million diagnosed12 million undiagnosedOne Death Every 4 minutesLeading Cause of DisabilityState COPD Action PlansNational Celebrity Spokesperson

Medicare Respiratory Therapy Initiative

COPDRecasts Emphysema and Tobacco to focus on Chronic DiseaseMove from Shame - Blame to prevention, treatment and managementNIH - NHLBI National Education and Awareness Campaign “Learn More Breathe Better”CDC Program in Chronic Disease Center

Medicare Respiratory Therapy Initiative

CDC Program in Chronic Disease Center PACT Appropriations Request Garnered Support

Udall (D-NM) Member SubcommitteePlaced Request at $6 Million

Larry GarlandBob Quintella

165/375 Members Indicated SupportOrganizational Sign-On LetterDear Colleague

Medicare Respiratory Therapy Initiative

Don’t Forget the Follow-Up:Extend an InvitationSchedule a District MeetingGenerate Patient SupportLetters to the Editor - Generate local press coverage

Medicare Respiratory Therapy Initiative

Let’s share informationTell us about your successTell us about your ideas

Medicare Respiratory Therapy Initiative

Thank You

Sherry Milligan

Cheryl West

Anne Marie Hummel

Respiratory Therapists

DISCUSSION

QUESTIONS

RECOMMENDATIONS