Read AOTA's Analysis of the Health reform Law (P.L. 111-148) (Update May 26, 2010)
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Update May 26, 2010
AOTA continues to update the Health Reform Hub and provide additional analysis of the health bill. As implementation gets underway AOTA will be following the regulatory process and commenting to both Congress and Federal agenxcies to ensure that the victories AOTA achieved in the bill are not lost in the implmentation process.
Update: Tuesday March 23, 2010
At the stroke of noon President Obama signed health care reform into law. Additional changes are likely if the Senate enacts the House passed Reconciliation Act but the overwhelming majority of health reform provisions have already been signed into law this afternoon.
Read: AOTA's OT Specific Analysis of the New Health Care Law
View: Timeline for Implementation of the Patient Protection and Affordable Care Act
Listen: AOTA's Newest Policy Podcast (19)
See AOTA's Health Care Reform Hub for other resources and direct access to the new law.
Health Reform Passes late on March 21, 2010
Stay tuned for additional information, but health care reform passed by a close party line vote in the House. The therapy cap exceptions process will be in place for the remainder of 2010 as soon as the legislation in signed into law by President Obama. The signing of the bill is planned for Tuesday 3/23/10. Additionally the Senate is expected to vote on the accompanying Reconciliation Act Tuesday is well. The Reconciliation act includes changes the House wanted in the health reform bill.
Update March 19, 2010
The House is poised to vote on health reform this Sunday (3/21/10). Passage is expected but the outcome is by no means decided at this point. Upon passage the Senate version of the bill will become law and remain subject to amendment through the reconciliation project that has received so much attention in the media. AOTA staff will be providing updates as soon as details are available. The bill includes many important provisions for OT including an extension of the Medicare therapy cap exceptions process among others.
Update March 12, 2010
The plan for moving forward on health reform is now again in full swing. Democratic Leadership from the House, Senate and White House are all meeting to decide on what will and will not be in the package of amendments to the Senate bill that will need to be enacted in order to garner the necessary House votes for the underlying Senate bill.
The amendments being packaged are likely to be moved through the Senate using the reconciliation process that allows the Senate to enact legislation with a simple majority vote. Reconciliation however is subject to the Byrd Rule which requires all provisions in the reconciliation package to impact federal spending as either additional cost or savings. This rule limits the scope of what can be included in the reconciliation package.
It is expected that the House will vote on the Senate bill next week and then immediately pass the “reconciliation” package amending the bill. The Senate must then pass the amendment package probably through the use of the reconciliation process.
AOTA is following the process closely and continues to work to see AOTA priorities remain in the final legislation. The outcome of the upcoming votes remains somewhat unclear. For occupational therapy practitioners and the clients we serve a large complicating factor is that the therapy cap exceptions extension and other important tax and Medicare extenders are now wrapped up in the reform bill and that bill represents the first chance to pass extensions to provisions that are expiring at the end of the month.
Update February 22, 2010
President Obama has released a summary of the administrations health care reform proposal aimed at reviving the health reform debate. A summary of the proposal can be found here.
Udpate February 19, 2010
Congressional leaders and the President continue to work towards an agreement on health care reform that could garner the necessary votes in both houses of Congress. President Obama has renewed his efforts to revive the debate and has scheduled a bi-partisn summit for February 25, that will be televised live.
House
http://polis.house.gov/UploadedFiles/2-3_P olisPingreeLetter.pdf
Senate
http://whipcongress.com/letter-senate?source=med
Update February 10, 2010
While health reform remains stalled Congress has not given up. Several health provisions are incuded in the current Senate Jobs bill. A 1 year extension of the therapy cap exceptions process is included in the bill extending the exceptions process retroactively from January 1 to December 31, 2010. A physician fee schedule update was also included to avoid Medicare payment cuts through September 30, 2010. The short extension leaves the door open for Congress to move forward with health reform efforts again later in the year. Continue to follow the Legislative Action Center to keep up to date on reform and all of the other federal issues impacting occupational therapy.
Update January 27, 2010
Democratic Leaders in the House and Senate have been struggling to find a way to move forward with health reform after last week's stunning defeat in Massachusetts. While reform remains a top priority for both the President and the Democratic majority in Congress, there is a sense that the process by which they achieve reform may itself need to change. President Obama's State of the Union speech this evening could be very enlightening about not only the direction but also the tenor of ongoing reform efforts. The President is not expected to spend the majority of his time on health reform but his remarks in that area should help determine the path forward.
AOTA remains engaged with Congress on health reform and is meeting daily with Members of Congress, their staff and other like minded advocacy groups to see that the positive aspects of reform are not lost in the political shuffle and that Congress passes meaningful reform. As always AOTA is fighting for occupational therapy priorities. We are doing that now within the context of reform but also developing alternative strategies in case reform is stalled more indefinitely.
Important issues like the Medicare Therapy Cap, OT as a Medicare initiating service, expanded coverage of habilitation and rehabilitation services, , expanded health care for children under Medicaid and CHIP, OT workforce and training issues are all before Congress now because AOTA has placed them there. We will continue to work on these issues and gain victories regardless of what direction Congress takes with overall reform.
Please continue to use the Take Action button to support AOTA's advocacy efforts and to be sure that Congress hears from YOU, the frontline health care providers. Also check the other Action Alerts on the Legisaltive Action Center as AOTA begins to focus on other specific policy priorities both within and seperate from health reform.
Update January 20, 2010
On Tuesday January 19 Scott Brown (R-MA) became the first Republican Senator from Massachusetts in over 50 years. The remarkable GOP victory has significant political implications in Washington providing Republicans with 41 seats in the Senate.
According to state law the election cannot be certified in less than 2 weeks but there has been precedent for moving more quickly to seat a Senator elect who has won in a convincing manner as Brown did last evening. He defeated Martha Coakley by just under 5 percentage points after trailing by as many 30 points just weeks ago.
The Republican victory has significantly changed the political landscape in Washington breaking the Democrats' complete control of the US Senate. It is expected that the outcome of the special election will be a delay in the health reform process and a likely re-tooling of the bill.
AOTA is actively working with Congress to move forward with meaningful reform and to address immediate concerns such as the Medicare fee schedule and the therapy caps. A current short term fix for the Medicare fee schedule is set to expire by February and Congress will need to move legislation in order to avoid the scheduled 20 percent cut to all Medicare providers. AOTA will work to see that an extension of the therapy cap exceptions process is included in the first piece of health care legislation Congress enacts this year.
Update January 15, 2010
While Congress has been in recess for the holidays the unofficial conference referenced below has been in high gear. House and Senate negotiators are nearing completion of a compromise bill that each would bring back to their respective chambers for a final vote. Action could come as early as next week, with additional pressure being put on the Democrats because of the surprisingly close race in Massachusetts between Republican Candidate Scott Brown and Democratic Candidate Martha Coakley. Some polls even have the Republican ahead in what has historically been a very Democratic leaning state. The loss of the seat, held previously by the late Ted Kennedy, would strip the Democrats of their absolute control in the US Senate.
AOTA has achieved many victories in the legislation but continues to work for inclusion of our home health provision in the final version of the bill. Currently it is only part of the House package though a bi-partisan amendment to include the provision was filed in the Senate by Senators Cardin (D-MD), Ensign (R-NV), Johnson (D-SD) and Vitter (R-LA).
Federal affairs staff have also recently produced another in a series of Podcast regarding health reform. That update is available at: http://www.talkshoe.com/talkshoe/web/talkCast.jsp?masterId=28233&cmd=tc
Update: January 6, 2010
An “unofficial conference” comprised of key members of both the House and Senate will be working to craft a single piece of legislation that could be passed by both chambers. Indications are that the "unofficial conference" will be amedning the Senate bill which will be sent to the House then back to the Sente before being sent to President Obama.
The House and Senate are officially recessed until January 12th and 19th respectively. However, unofficial discussions have begun regarding the merging of the House and Senate health reform bills. Issues regarding the Medicare Part D doughnut hole, the employer mandate, affordability and public funding for abortion appear to be at the center of these early discussions with the ultimate goal being a finished product on the Presidents desk sometime in February.
AOTA staff continues to work with key members of both the House and Senate to protect and advance the interests of occupational therapy and its patients in the final health care package.
Update: December 24, 2009
Today the Senate has successfully passed the "Patient Protection and Affordable Care Act” (H.R. 3590). It was a 60-39 party line vote with all Democrats and Democratic leaning independents voting for the bill with all Republicans opposed. Senator Bunning (R-KY) did not vote. The Senate joins the House in passing significant reform legislation but many variations remain between the bills. House and Senate Democratic Leaders are expected to conference and merge the bills in early January and attempt to bring a bill to the floor of each chamber for final passage before President Obama’s State of the Union speech in late January.
The bill includes many important victories AOTA has fought for such as an extension to the therapy cap exceptions process, the inclusion of rehabilitation and habilitations services as required categories of service under the mandatory benefits package, a Medicare payment update to replace a 21.2 percent cut with a small increase, expansion of Medicaid including service mandates for children that include occupational therapy and workforce training and education provisions that explicitly recognize occupational therapy. These are just a few of the important improvements found in the bill.
Check AOTA’s Health Reform Hub now and again in coming days for additional information including the text full of the bill, section–by section analysis and a more detailed description of the bills potential impact on occupational therapy. A new OT specific analysis of the Senate bill is also now available on the Health Reform Hub.
AOTA continues to work with both the House and Senate for inclusion of Section 1155B of the House bill in the final merged bill that would allow occupational therapists to open Medicare Home Health cases and conduct the initial visit and assessments. Use the Take Action button to send the appropriate message to your Members of Congress in support of this effort.
Tuesday December 22, 2009
Just after 1am on Monday morning the Senate successfully completed its first of three votes to end debate and move to proceed toward a final floor vote on the "Patient Protection and Affordable Care Act” (H.R. 3590). The Democrats won just the 60 votes they needed to pass the procedural motion. All Republicans voted against the motion with all the Democrats and two independents voting for passage. Since then another vote has been completed with identical outcome and Majority Leader Harry Reid's Manager's Amendment that includes all leadership approved amendments to the underlying bill was also passed by the 60 vote margin. An additional and final cloture vote is expected early Wednesday morning with a final vote up or down on the Senate Health reform bill could come as early as noon or 1 pm on Christmas Eve.
See AOTA's Health Reform Care Hub to read copies of the Senate bill and Senator Reid's Manager's Amendment. Additionally a side-by-side comparison of the current House and Senate Democrat Leadership bills is available there as well. AOTA is continuing to work with Congressional leadership to gain inclusion of AOTA's home health provision that would make occupational therapy eligible to conduct the initial visit for Medicare Home Health beneficiaries. That provision is in the House bill but is not included in the Senate version. AOTA is working with key Senators and House leaders to work toward the Senate accepting the House language in that section during the reform process. The Take Action button allows you to send the appropriate message to your Members of Congress to support that effort.
Thursday, December 10, 2009
Senate Continues Floor Debate on Health care
Senator Benjamin Cardin (D-MD) and Senator John Ensign (R-NV) have filed Senate Amendment 2976 to the "Patient Protection and Affordable Care Act" to make occupational therapy an initiating service in Medicare home health. AOTA is working diligently with staff from both offices to secure bipartisan support and co-sponsorship for this important amendment.
AOTA continues to monitor the debate in order to protect and advance the interests of the profession of occupational therapy and its patients.
Thursday, December 3
Health Reform Bill on Senate Floor for Debate
The Senate health care reform bill “Patient Protection and Affordable Care Act” will go to the Senate Floor for debate November 30, 2009, around 3:00 p.m. On November 21 the Senate passed the 60-39 vote to proceed with the debate of the health care reform bill. A few of the controversial issues in the Senate bill include the debate about the public option, the Stupak amendment (restricts federal funding from covering abortions), and coverage for illegal immigrants.
AOTA pushed for many occupational therapy initiatives to be included in the Senate bill —coverage for rehabilitation and habilitation services, two-year extension of the exceptions process for the Medicare Outpatient Therapy Caps, and occupational therapy’s inclusion in the workforce section of the bill—and was able to get these initiatives into the final version of the bill. AOTA lobbied Senators to include the explicit language “rehabilitation and habilitation and devices” in order to ensure occupational therapy services were covered. Technically, occupational therapy would have been covered under hospital, outpatient, and pediatric services; however, AOTA, along with the Consortium for Citizens with Disabilities, wanted to see the specific language in the bill so that it can not be open for interpretation in the future. The language for the two-year extension of the exceptions process for the Medicare Outpatient Therapy Caps would allow beneficiaries to exceed the caps in order to receive the rehabilitation they need. AOTA also pushed for specific inclusion of occupational therapy in the workforce definitions. Initially, occupational therapy was included under the workforce provisions as allied health professionals; however, AOTA wanted to see the explicit occupational therapy language in the bill in order to prevent confusion in the future.
AOTA is currently working with Senator Ben Cardin (D-MD) to introduce on the Senate floor the home health amendment that would improve efficiency and effectiveness of home health for Medicare beneficiaries by allowing occupational therapists to open cases and conduct the initial and comprehensive assessment for Medicare home health beneficiaries when occupational therapy is on the physician’s order with a qualifying service. This amendment has zero cost and has no opposition. Please use the
After the Senators debate the health reform bill, they will need a majority vote on the final form before it can progress any further but may need 60 votes to end debate. If this bill passes the Senate, it will go to a conference committee to reconcile the differences between the House and Senate versions of the bill. When the two chambers reach a compromised version of the bill, it will be voted on in both the House and the Senate. If it passes in each chamber, it then goes to the President for signature into law. Debate on the health care reform legislation may push into the beginning of next year.
Monday, November 30
The Senate begins debate today at 3 pm on the Patient Protection and Affordable Care Act. Current indications are that debate will last for several weeks and could continue into the new year.
Federal Affairs staff are working to protect and advance the interests of the profession including continued work to garner bi-partisan support for an amendment making OT and initiatibng service in Medicare home health.
November 23, 2009
On Saturday, November 21 the Senate voted to move forward with debate on the Senate health care reform legislation. As expected, the vote was successful along party lines with all Democrats voting in favor of the motion to proceed. All Republicans voted against the motion except Sen. Voinovich (R-OH) who was not in Washington at the time of the vote. Further action in the Senate is likely to be delayed until after the Thanksgiving holiday. December should prove extremely active in the Senate as they attempt to wrap up deliberations before the new year.
November 19, 2009
Senator Harry Reid has introduced the Patient Protection and Affordable Care Act, which is a merged version of the seperate reform proposals passed by the Senate Health Education Labor and Pensions (H.E.L.P) and Finance committees. Current indications are that debate will begin at the end of this week or early next week. The full text of the bill can be found at: http://democrats.senate.gov/reform/patient-protection-affordable-care-act.pdf
AOTA achieved a major victory in gaining specific inclusion of occupational therapists in the definitions of health care workforce and health professionals included in the workforce section of the bill providing loan and grant repayments.
November 7, 2009
The House of Representatives took a historic step towards passing health care reform legislation Saturday night when the Affordable Health Care For America Act was passed with a 220-215 vote. This legislation includes language to make OT an initiating services as well as other provisions benefitting the profession. Thirty nine Democrats broke from the majority and voted against the legislation while only one Republican, Joseaph Cao from Louisiana voted in favor of the bill.
The Senate is currently waiting for their health care reform legislation to be scored by the Congressional Budget Office (CBO). AOTA's federal affairs staff continues to work diligently to protect and advance the interests of occupational therapy in the Senate.
October 22, 2009
The Senate today failed to move forward in the process of addressing the scheduled 20% cut to the physician fee schedule. The Senate did not gain the 60 votes necessary to move forward with a proposal to eliminate the 20% cut that would take effect as of January 1, 2010. This development further slows the reform process as the physician fee schedule cut is one of the several key provisions that must be dealt with this year.
Additional action on the larger health reform bills is expected by the second week of November at the earliest. Both the House and Senate leadership are in the process of merging their separate bills so that each chamber will have a bill to move to the floor for a vote sometime in November.
AOTA continues to monitor progress on reform and is actively working on AOTA priorities like the therapy cap, home health and protecting the occupational therapy scope of practice.
Update October 2, 2009
The Senate Finance Committee has completed it's deliberations of the America's Healthy Future Act and is expected to vote on the bill in Committee next week. The mark-up process delivered several important legislative victories for AOTA in regard to orthotics & prosthetics, direct access and the Medicare therapy caps. AOTA continues to wok in both the House and Senate and is confident of significant progress on additional AOTA reform priorities. The legislative language from the Finance mark-up is not yet available but AOTA will provide the language and analysis of key provisions as soon as it is available. Additional details will be available early next week so be sure to check back to learn more about what AOTA has
AOTA staff are deep in preparations for Monday's Capitol Hill Day which could not have come at a more opportune time. More than 300 AOTA members from around the country are coming to Washington on Monday October 5th to advocate for OT at this critical time in the health reform debate. Even if you can't come to Washington Monday you can still support your colleagues and profession by participating in AOTA's Virtual Hill Day. Additionally, occupational therapy Program Directors and the AOTA Board of Directors will be having Hill Days over the coming month. AOTA's final in-person Hill Day will be on Friday November 2oth as part of the Student Conclave. Watch for other possible Virtual Hill Days to address AOTA policy priorities as the reform process continues to unfold over the remainder of the year.
Update September 16, 2009
After months of deliberation and debate with the bipartisan "Gang of Six" Senate Finance Committee Chairman Max Baucus (D-MT) released the Chairman's mark of America's Healthy Future Act . The Finance Committee is expected to begin mark ups of the bill Monday September 21.
AOTA is continuing to work with the House and Senate Committees of Jurisdiction to advocate on behalf of occupational therapy and be sure that AOTA is part of the ongoing discussion on the Hill. Regular Reform Updates will be posted under this link in coming weeks.
Update September 8, 2009
Congress has returned from August Recess today and health care reform is again at the forefront of the Congressional agenda. The Senate and the country is still dealing with the passing of Senator Ted Kennedy (D-MA) who had long been a champion for health reform and whose leadership will be missed. Senator Tom Harkin(D-IA) will take over the Chairmanship of the Senate HELP Committee after Senator Dodd (D-CT) decided not to assume the leadership role of the Committee given his other responsibilities in the areas of banking and housing.
The Senate Finance Committee recently released a Health Reform Framework intended to engage Senators who are part of the Gang of Six; moderate Republicans and Democratic willing to work on negotiating a compromise on meaningful health reform. The Gang of Six include: Chairman Max Baucus (D-MT), Ranking Member Chuck Grassley (R-IA), Olympia Snowe (R-ME), Kent Conrad (D-ND), Mike Enzi (R-WY), Jeff Bingaman (D-NM).
Quick Links:
- Update - August Recess, 2009
- Update - July 30, 2009
- Update - July 27, 2009
- Update - June 29, 2009
- Update - June 18, 2009
- Update - June 9, 2009
- The House Bill
- The Senate Bill
- AOTA's Position
- AOTA's Concerns
- Issues of Particular Interest to Occupational Therapy Practitioners
- Important Links and Documents
Update August Recess 2009
Congress has largely adjourned for August Recess and has left much work yet to be done on health reform legislation. (The Senate is expected to adjourn tonight or tomorrow.) This break gives Members of Congress and the rest of us a chance to listen, learn and advocate about health reform and what it could mean for the country in general and for occupational therapy specifically. The debate is raging back and forth and there is little doubt that there are many opinions among policy makers and the public. Many talk about the consequences of doing nothing and others talk about acting to fast and too big and getting it wrong. The rhetoric on both sides is heated and voluminous.
In this update AOTA Federal Affairs staff are providing direct information about what is included in the current form of the House and Senate bills that have successfully moved through the committees of jurisdiction with analysis of how relevant provisions would impact occupational therapy. Additionally we are providing a series of links that provide detailed information about topics many AOTA members may have particular interest in, such as autism, CHIP, Medicaid and other key issues.
Lay of the Land - Currently the three House Committees (Ways and Means, Education and Labor and Energy and Commerce) have completed their work on America's Affordable Health Choices Act of 2009; each committee moved forward a slightly different version. Committee staff and leadership are working to merge the three versions of the House bill to bring the legislation to the floor for debate and a vote in September. Significant changes likely lay ahead of the House bill before a vote but the information below is current as of the date of publication.
In the Senate, the Health, Education, Labor and Pensions Committee (HELP) has completed their work and favorably reported a bill, along partisan lines. The Senate Finance Committee is also working on draft legislation expected to be released after recess and that Committee has targeted September 15 for marking up the bill. So each Chamber is expected to move quickly upon return to Washington. After the House and Senate finish their bills they will merge during a very important conference session and then offer a single bill for final debate and vote. Timing of that final stage is not yet set. It is AOTA's view that health care reform legislation will move forward but the final version may be far less sweeping and more incremental than what is currently being discussed. AOTA believes that it is critical that occupational therapy have a strong voice in the debate focused on areas of particular interest and impact on occupational therapy and the people we serve. Health care reform will be the main topic of AOTA's Capitol Hill Day on Monday October 5, 2009.
The House Bill - America’s Affordable Health Choices Act of 2009 (HR 3200):
This legislation expands coverage to currently uninsured Americans by expanding Medicaid and coupling health insurance subsidies with a mandate to obtain coverage enforced through tax penalties. The bill creates and exchange under which health insurance plans will compete with each other and potentially with a public option. The exchange or gateway, as termed in the Senate, would have minimum coverage requirements and benefit requirements that have yet to be fully developed. It would also mandate insurance market reforms, such as eliminating pre-existing condition denials.
The bill makes significant changes to Medicare, including spending cuts totaling hundreds of billions of dollars. Additional revenue to fund the expansions in the bill would come from raised taxation on higher-income Americans.
In specific regard to occupational therapy, the plan does extend the current therapy cap exceptions process for two years. It also eliminates currently planned cuts for the physician fee schedule and replaces them with a modest increase for the next several years. Additionally occupational therapy, as an allied health profession, is potentially eligible for some workforce incentives.
More information about Medicaid provisions is available here. Detailed information about Medicare provisions is available here.
The Senate Bill:
The Senate bill has been addressed solely by the HELP Committee and does not include any Medicare provisions at this time. Also, unlike the House bill, the Senate bill does include long-term care provisions and reforms including the CLASS Act. AOTA has supported passage of the CLASS Act since introduction in the previous 110th Congress.
A helpful interactive tool for comparison is the Kaiser Family Foundation Side-by-Side Comparison of Major Health Reform Proposals. The Kaiser Family Foundation.website also has other useful resources on Health Care reform.
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Issues of Particular Interest to Occupational Therapy Practitioners
Several issues currently included or under discussion in the House bills are directly related to or have a potential to significantly impact occupational therapy and the populations we serve. They include:
- Occupational Therapy in Medicare Home Health:
AOTA is working closely with the House Ways & Means and Energy & Commerce Committees to gain inclusion of the purpose of the Medicare Home Health Flexibility Act (HR 1094) into the House health care reform bill before it moves to the floor in September. The provision would allow occupational therapy to become an initating service for Medicare home health cases and raise the profile and role of occupational therapists in the home health setting.
- Proposed Tax Provisions in Tri-Committee Bill
- Individual Surcharge - The nonpartisan Joint Committee on Taxation has estimated that the health care surcharge would only apply to the top 1.2% of all households in the United States. The health care surcharge only applies to income earned in excess of $350,000.
- A family making $350,000 would not owe any surcharge at all.
- A family making $400,000 would contribute $500 to help provide access to affordable health care for all Americans – 0.13% of their annual income.
- A family making $500,000 would contribute $1,500 to help provide access to affordable health care for all Americans – 0.3% of their annual income.
- A family making $1,000,000 would contribute $9,000 to help provide access to affordable health care for all Americans – 0.9% of their annual income.
- Small Business Surcharge - The nonpartisan Joint Committee on Taxation has estimated that only 4.1% of all small business owners would be affected by the health care surcharge. Any employer that does not elect to provide health benefits to its employees would generally be subject to an additional payroll tax equal to 8% of wages (commonly referred to as the "play or pay" mandate). An amendment introduced by Rep. Mike Ross (D-AR) and accepted by the Energy and Commerce Committee would set the penalty for small business at a graduated rate for businesses with an annual payroll between $500,000 and $750,000:
If the annual payroll of such employer for the preceding calendar year:
- Does not exceed $500,000 - 0 percent
- Exceeds $500,000, but does not exceed $585,000 - 2 percent
- Exceeds $585,000, but does not exceed $670,000 - 4 percent
- Exceeds $670,000, but does not exceed $750,000 - 6 percent
- Other Key Medicare Provisions - Medicare cuts are a significant part of health care reform proposals coming before Congress. Although the Senate has not put forward a final proposal, the bills on the House side have what many are calling draconian cuts in order to “bend the curve” of health care spending. The belief is that Medicare spending must be curtailed. The cuts are to provider payments and not on benefits, But the fallout from these changes could have an impact on access to services for beneficiaries. Certainly there may be direct effects on occupational therapy practitioners in all settings. The funds from the cuts are part of the pool of resources, which includes a variety of tax and other options, to fund increasing access to
- Hospitals: The bills include a permanent annual reduction to the Medicare inpatient market basket update that could cut hospital payments in all service areas by an estimated $150 billion or more over 10 years.
- Home Health: The home health cuts in the House Tri-Committee health care reform proposal would take $56.8 billion over ten years from a Medicare benefit that expends about $16.4 billion per year ($1 billion less than in 1997) and under control in terms of expenditure growth.
- Skilled Nursing Facilities: Cuts to Medicare payments for Skilled Nursing Facilities amount to at least $44.9 billion over ten years. SNFs care for 1.5 million Americans each day and employ 1.7 million people across the country. SNFs argue that Medicare funding is critical because it props up inadequate Medicaid payments. Studies demonstrate that state Medicaid programs pay $4 billion a year less than the cost of care.
- Bundling: There is a proposal for a demonstration project to explore “bundling” care for not only an acute care episode but also to include the 30 days post-acute care in the hospital payment. The demonstration project was in response to opposition to full and immediate implementation.
- Nursing Home Transparency: There are a variety of proposals to improve the public’s ability to know and understand what happens in skilled nursing facilities. Nursing Home Compare, the public listing of information on skilled nursing facilities, will be expanded to include staffing data including direct and indirect, as well as administrative and overhead information. Whistleblower protections for those employees who lodge.
- Productivity: The House draft reform proposal includes a "productivity adjustment" that would reduce annual inpatient, outpatient, inpatient rehabilitation (IRF), long-term care hospital, psychiatric hospital, skilled nursing facility (SNF) and home health agency market basket updates by "productivity growth" (estimated at 1.3% for FY 2010). How this productivity adjustment would actually work is not clear but it is related to larger economic productivity.
- Telehealth:
The Energy and Commerce Committee has accepted Representative Mike Thompson’s (D-CA) amendment to “America’s Affordable Health Choices Act of 2009,” H.R. 3200 that includes portions of HR 2068, the Medicare Telehealth Enhancement Act of 2009. The accepted amendment creates a telehealth advisory committee composed of 9 members to include 5 practicing physicians, 2 practicing non-physician health care practitioners, and 2 administrators of telehealth programs.
AOTA continues to work with other interested stakeholders to push for the inclusion of other provisions of HR 2068 including the expansion of the list of eligible providers of telehealth services covered under Medicare to include occupational therapy practitioners and other non-physician providers.
The accepted amendment language can be found beginning on pg. 379 of the Affordable Health Choices Act 9HR 3200) of 2009.
- Autism:
The U.S. House Energy and Commerce Committee accepted an amendment from to HR 3200 Rep. Mike Doyle (D-PA), which flowed from his previously introduced bill regarding services for individuals with autism. Rep. Doyle's remarks at the Committee also supported that his intent was to assure coverage of services for autism. However, the amendment simply adds "behavioral health treatments" to the definition of mental health services in the bill. AOTA's conversations with Rep. Doyle's staff indicate his intent was to assure that all services be available for individuals with autism, including occupational therapy. AOTA will continue to follow up with Mr. Doyle to assure the language will be interpreted as including occupational therapy. Mr. Doyle serves as Chairman of the Congressional Autism Research and Education Caucus in the House. The bill and amendment were supported by Autism Speaks.
The full amendment language can be found here.
A full list and text of the Energy and Commerce Amendments can be found here.
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Politics
While AOTA takes no position regarding the politics of health reform, it is impossible to debate the merits of the various proposals in a vacuum. Therefore we have provided the following links from various perspectives to better inform the debate:
Health Care Policy Recommendations and Analysis from the Conservative Leaning Heritage Foundation
Health Care Reform Page for House Minority Leader John Boehner (R-OH)
Analysis and Comment from the Liberal Leaning Center on Budget and Policy Priorities
Health Care Reform Page for Speaker of the House Nancy Pelosi (D-CA)
Past Updates
Update July 30, 2009
House and Senate Committees Continue to Debate Health Care Reform Proposals
The Energy and Commerce Committee resumed “mark-up” today on HR 3200, the health care reform proposal called the “Tri-Committee Bill.” Blue Dog conservative Democratic members raised objections last week and successfully entered into negotiations with Chairman Henry Waxman, Speaker Nancy Pelosi, and even President Obama. The Blue Dogs voiced concerns about the timetable for action before August as well as concerns about some policy aspects of the bill. Their push-back worked and compromises were achieved that appear to save about $100 billion dollars. However, the details have not yet been released and supporters of a robust public plan are concerned that area may have been weakened. Other Blue Dog changes include protections for small businesses with payrolls of less than $500,000 per year.
AOTA staff are in the Committee room monitoring the action and working to get the home health provision in as well as assure that no changes to benefits, coverage, payment levels and other issues are made more difficult for occupational therapy practitioners and their patients.
To voice your concerns and to ask questions and get the real story on what is happening, participate in the Health Care Reform forum on OT Connections here. (You may have to login first to access this page.)
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Udate July 27, 2009
The health care debate continues on Capitol Hill as both the Senate Finance Committee and House Energy and Commerce Committee continue to meet privately to reach agreement on their respective health care reform proposals.
The Energy and Commerce Committee continues to work towards their goal of reaching a compromise and passing a bill out of committee before the August recess, while the Senate leadership has stated that they will not be voting on a health reform bill before September.
Valuable resources containing arguments from both sides of the health care debate can be found below:
House Energy and Commerce Committee district by district analysis
Capital Malpractice - How a Washington Takeover will Hurt States
Arena Debate: Healthcare-The Public Option/a>
The Health Care Crisis and What to Do About It -- By Paul Krugman, and Robin Wells
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Update July 21, 2009
Senate Health Education Labor and Pensions (HELP) Committee and House Tri-Committee Introduce Health Care Reform Legislation
The Senate HELP Committee finalized their initial health care reform proposal on July 15, 2009. AOTA has recieved a section by section analysis of the bill which can be viewed here.
The House Tri-Committe released their health care reform proposal on July 14, 2009. AOTA has recieved a copy of the health reform bill introduced as H.R. 3200, “America’s Affordable Health Choices Act of 2009.”. You may view the text here.
A summary of the Bill can be found at here.
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Update June 29, 2009
Details of Health Reform Proposals Begin Take Shape-
With various pieces of health reform legislation in various states of preparedness, it is becoming more and more challenging to see the path to health reform. With that said however, details of various plans are emerging and areas of similarity are developing that may provide a framework for reform once the key political stakeholders begin to negotiate in earnest. To help you navigate the facts of the health care reform proposals the Kaiser Family Foundation has prepared an interactive website that is a helpful resource for learning more about the current proposals:
Among the issues of specific interest to occupational therapy practitioners in the discussion draft is a proposed 2 year extension of the current therapy cap exception process. Please check back regularly at the
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Update June 18, 2009
Heath Care Reform Heats Up on Capitol Hill- AOTA Active in the House and Senate!
Both the House and Senate are actively engaged in hearings and mark ups related to health care reform. In the Senate the Health, Education, Labor and Pensions Committee led by Chairman Kennedy (D_MA) and Ranking Member Enzi (R-WY) have introduced a 615 page bill titled the Affordable Health Choices Act and have already begun the technical process of marking up the bill in Committee. The Finance Committee has delayed their introduction and hearing regarding a separate health care reform bill. Both Committees are struggling with very large scores from the Congressional Budget Office (CBO) in excess of a trillion dollars; particularly under President Obama's pledge to pay for health care reform within the budget. The Committees are looking at various ways to reduce costs and raise revenue to pay for health care reform and coverage of the nearly 49million Americans who are currently without coverage. Some of the proposed savings could result from Medicare and Medicaid cuts. AOTA is working closely with Congress to ensure that occupational therapy is well represented in the health care reform debate.
The House of Representatives is also moving forward with a single piece of health care reform legislation that will be marked up seperately in each of the three Committees of Jurisdiction in the House: the Ways & Means Committee, the Energy & Commerce Committee and the Education and Labor Committee.
The House Tri-Committees continue to actively engage in the health care reform debate with each committee holding multiple hearings this week to discuss specifics of the proposed legislation. A good portion of the debate focused on the idea of a public plan option.
The debate surrounding the public option is split down party lines with the Republicans in opposition arguing against the public plan stating that it will lead to government rationing of care and will be the first step toward a Canadian or Great Britain styled single payer system. Democrats in support of the public plan option argued adamantly against these assertions stating that this will not lead to rationing of care nor will it be a system similar to that of Great Britain or Canada but will be a uniquely American system focused on expanding coverage, increasing quality and efficiency while reducing overall cost.
During this past week’s hearings numerous issues important to the profession of occupational therapy were discussed. Of specific interest was a discussion in the Energy and Commerce committee where the expansion of EPSDT services into CHIP and the proposed exchange program currently included in the House Tri-Committee Discussion Draft. Other pertinent discussions included the need to address health care workforce issues, health information technology, the role of early intervention services, and the need to include comprehensive minimum benefit packages in the proposed public plan.
While Senator Kennedy and others remain steadfastly committed to passing health care reform legislation in each Chamber before the August Recess, the timeline is becoming longer and longer, especially as concerns continue to grow regarding the cost of the bills and how Congress will find the money to offset such significant spending increases on health care. Continue to check back regularly and reach out to your Members of Congress to be sure they hear the voice of occupational therapy.
You can also view AOTA's Fact Sheet on Health Care Reform for a one pager on AOTA's position.
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Update June 9, 2009
Health Care Reform
Since well before the November election health care reform has been front and center on the policy agenda in Washington. President Obama's election to office and Democratic gains in both the House and Senate have only increased the momentum toward enacting significant health reform.
Several plans have been presented by leaders in the House, Senate and from the White House. While variations far outweigh the similarities between the plans at this point, there are some important areas of agreement. Among these, some of the most significant include expansion of coverage for the uninsured, the adoption of health information technology and emphasizing a prevention and health promotion philosophy.
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The American Occupational Therapy Association (AOTA) agrees with the growing consensus that there is a need for reform in the American health care system to address problems including coverage for the uninsured, access to care, quality, cost growth and workforce shortages. As the professional association representing the interests of more than 140,000 occupational therapy practitioners and students, AOTA believes that a national debate and discussion about health care is needed.
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- Health care must have a proactive, prevention focus.
- Health care must address the whole person across the lifespan and across needs for acute and chronic care.
- Mental health and substance abuse parity must be included for all.
- The provision of health care services should be integrated across facilities, communities, and settings, including services where people live, work and participate in society.
- Access to quality, affordable care for all should be the goal of reform.
- Ensuring access to supportive services for people with disabilities or chronic conditions is essential to promoting independence, productivity and quality of life.
- Investments are needed in our health care education system to ensure availability of qualified professionals like occupational therapy practitioners to meet growing needs.
- Occupational therapy should be covered to provide preventive services, rehabilitation and habilitation, community and facility services, and any other approach that evidence shows occupational therapy improves quality of life.
- Use of health information technology must be maximized to improve the efficiency and effectiveness of care.
Enacting meaningful reform requires a bi-partisan approach that has the vision and commitment to invest in a system of health care even if it may cost more in the present to provide savings and improved outcomes through efficiency and quality in the future. Any health care reform must more equally and equitably distribute the costs and benefits of quality health care to all who need it for the benefit of individuals and society.
For more information about AOTA's vision for health care reform contact AOTA's Federal Affairs Department at fad @ aota.org
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AOTA has been actively working on health care reform through meetings with Congressional offices and the Obama transition team. In an effort to keep practitioners abreast of how the health care reform debate is taking shape we have provided some important documents below.
House of Representatives Tri-Committee Health Care Reform Resources
June 9, 2009: Senate Health Education, Labor and Pensions Committee Health Care Reform Proposal, Affordable Health Choices Act (Senator Kennedy(D-MA)- Chairman)
OT Practice Article on Health reform by Christina Metzler, AOTA Chief Public Affairs Officer
Senate Finance Committee Chairman Max Baucus (D- Mont.) White Paper on Health Care Reform
Finance Committee Description of Policy Options
Congressional Budget Office (CBO) Statement of CBO Executive Director Douglas W. Elmendorf on Expanding Health Care Coverage and Controlling Costs in Health Care.
A Brief Summary and link to additional information about the bi-partisan Wyden/Bennett- Healthy Americans Act4 - This is from the Center on Budget and Policy Priorities.
AOTA Federal Advocacy Highlights Article on Health Care Reform
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Contact your Senators and Representative and educate them about occupational therapy's role in healthcare, wellness and prevention. Urge them to ensure that occupational therapy remains a covered benefit for all beneficiaries who need OT. Use the form letter below, but be sure to add your own details, thoughts and examples.
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| Back to the Heath Care Reform Hub |
The Senate Finance Committee has wrapped up their mark-up of the America's Healthy Future Act and the process included several very positive outcomes for occupational therapy. AOTA scored several victories around provisions related to orthotics & prosthetics, direct access, and the Medicare therapy caps. Additionally AOTA is confidently working on several other issues that would have a positive impact on occupational therapy access. Final legislative language from the mark up will be available shortly and AOTA will provide more details soon.
Timing could not be better for AOTA's Capitol Hill Day set for Monday October 5th. More than 300 AOTA members from across the country are headed to Washington to advocate for OT at this critical time in the health reform debate. Even if you can't come to Washington on Monday you can still take part and support your colleagues. Call and e-mail Congress by participating in AOTA's Virtual Hill Day. So far AOTA priorities are making good progress in the health reform debate but we are far from the finish line. Take Action today to advocate for OT.
Update September 25, 2009
The Senate Finance Committee has begun their legislative process in earnest over the past two weeks. AOTA has been extremely active with Finance Committee staff as well as individual Senators on that Committee in our advocacy for occupational therapy. A list of Finance Committee amendments and additional details about the bill are available at the Legislation Page of the Finance Committee website.
AOTA is working with targeted Affiliated State Presidents to guide direct advocacy to key members of the Committee. AOTA has had strong support from Senator Sherrod Brown (D-OH) and Senator Charles Schumer (D-NY) on some important advocacy issues that directly relate to occupational therapy. While the Committee has recessed for the weekend, they will return to session on Tuesday to continue their mark-up.
Senate Finance Committee passes their health reform bill, the America's Healthy Future Act, out of committee by a vote of 14-9. All Democrats voted for the bill while Senator Olympia Snowe (R-ME) was the only Republican Senator on the Finance Committee to vote in favor of the bill.All other Republicans voted no. AOTA is working on a summary of key provisions that will be posted here shortly. While this is an important development, significant work in both the House and Senate remains to be done before a final health reform bill is crafted.
October 7, 2009
Things are a little quieter this week but things continue to crop up that require advocacy on the part of every occupational therapy practitioner:
There is talk that the orthotics and prosthetics changes we pushed back in Finance Committee may come back up. We must express concern to every Member of Congress.
The home health change to expand the role of occupational therapy is still pending in both the House and the Senate. Continue to push for this recognition of the value of OT.
While the proposed amendment to give “direct access” only to physical therapists did not come forward, we must be sure that the study that was included in the Finance proposal continues to allow study of direct access to occupational therapy.
The Finance Committee may not meet until next week to cast a vote on the American’s Healthy Future Act so now is the time to make your voice heard!
Update March 4, 2010
After the recent passage of a short term Medicare extenders package including an extension of the therapy cap exceptions process and an update of the fee schedule through March Congress has again turned their full attention to health reform. President Obama has convinced Democratic Congressional leader to move forward with a strategy to complete health reform over the next several weeks.
The plan is to have the House of Representatives pass the Senate version of health reform and then pass a reconciliation package of amendments to change the bill. The Senate would then have to pass the reconciliation package to bring the final legislation into alignment before it could go to the President for signature into law. Reconciliation has rules that require all provisions addressed under the reconciliation process must have some impact on federal spending, either spending or savings. Reconciliation will be used by the Democrats because Senate rules allow legislation to be passed under that process with just a simple majority.
AOTA will continue to work with Congress to extend the exceptions process beyond the 1 year included in the original Senate bill. Additionally AOTA will be working on our other priorities such as the home health provision to allow occupational therapists to open Medicare home health assess and conduct the initial and comprehensive assessments for Medicare beneficiaries and securing a more permanent solution to the Medicare fee schedule and the therapy cap.
Advocacy efforts will be intense over the next few weeks with AOTA staff reaching out and utilizing the connections that OTA has developed over the years. Advocacy by AOTA members and leaders during this time will be critical. Please use AOTA's