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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
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