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!