Active Legislation

2018 Active Legislative Updates from ASHT

ASHT Pain Management Survey

As Congress continues to consider legislation to address the opioid epidemic, ASHT wants to hear from you!​

We want your voice and experience to resonate in this broader debate as ASHT continues to monitor these developments and work to shape policy to address the opioid epidemic. Knowing how you have helped clients manage chronic and acute pain through therapy and rehabilitation is a critical piece of the solution to this nationwide crisis. This survey should take approximately 5-10 minutes to complete. All answers provided will be kept in complete confidentiality. 

Thank you for taking the time to complete this brief survey examining the role hand therapists play in battling the opioid epidemic. The information gathered may be used and presented to physicians, insurers and legislators by ASHT.


May 1, 2018 

Congress Considers Legislation to Address the Opioid Epidemic – Hand Therapy Part of the Solution

Over the past few months, we’ve seen a flurry of debate on Capitol Hill around the opioid epidemic. This week marked the first significant steps taken this year toward advancing comprehensive legislation on this critical topic.

On April 24, the Senate Committee on Health, Education, Labor and Pensions (HELP) marked up S.2680: The Opioid Crisis Response Act of 2018. This bipartisan bill was a combination of 40 different policy proposals, cobbled together over seven bipartisan hearings on how to best address the opioid crisis. The Opioid Crisis Response Act of 2018 aims to accomplish many items, including:

Require the Secretary of HHS to provide technical assistance related to the use of alternatives to opioids, including for common painful conditions and certain patient populations, such as geriatric patients, pregnant women and children.

​Spur development and research on of non-addictive painkillers, and other strategies to prevent, treat and manage pain and substance use disorders through additional flexibility for the NIH.

Support the healthcare workforce by providing resources for pain care providers to assess, diagnose, prevent, treat and manage acute or chronic pain, as well as for the detection of early warning signs of opioid use disorders.

The Senate HELP Committee advanced S.2680 unanimously by a vote of 23-0. Chairman Lamar Alexander (R-KY) expressed his hopes that the full Senate will move the opioid legislation by this summer.

On April 30, the House Energy and Commerce Health Subcommittee concluded their opioid markup, advancing 56 opioid related bills to the full Energy and Commerce Committee. This full docket, comprised of introduced bills and draft legislation, offered a broad range of solutions to the crisis, across the areas of public health, behavioral health and Medicare and Medicaid reimbursement. According to Chairman Burgess (R-TX), the full committee markup is likely to take place in mid-May.

Among the drafts to advance was the Adding Resources on Non-Opioid Alternatives to the Medicare Handbook, which would direct CMS to compile educational resources for beneficiaries regarding opioid use, pain management and alternative pain management treatments. The legislation goes on to instruct CMS to include these resources in the “Medicare and You” handbook. Legislation like this gives ASHT the opportunity to emphasize the benefits of therapy as well as the work you do as therapists to minimize client pain and maximizing function.

As Congress continues to consider legislation like this to address the opioid epidemic, we want to hear from you! Knowing how you have helped clients manage chronic and acute pain through therapy and rehabilitation is a critical piece of the solution to this nationwide crisis.

We want your voice and experience to resonate in this broader debate as ASHT continues to monitor these developments and work to shape policy to address the opioid epidemic. Share your personal experiences, stories, and background to asht@asht.org, so we can tell Congress that Hand Therapy is part of the solution.  


April 6, 2018 

Hand Therapy Practice and the Opioid Epidemic

Hand therapists have a crucial role to play in addressing the opioid epidemic. Whether it is following an upper extremity injury, surgery, or helping manage a chronic condition, hand therapists provide safe, quality, and effective pain care management for their clients.

In recent months, Washington has turned its attention to the opioid epidemic, providing nearly $4 billion in new spending in the recent funding bill and debating dozens of bills to address the multi-faceted crisis. When Congress returns from recess next week, lawmakers will seek to continue the momentum.

On April 11th, the House Energy and Commerce Committee will hold a legislative hearing to examine a new slate of bills aimed at curbing opioid use by, among other things, addressing Medicare and Medicaid coverage barriers, tracking opioid prescribing patterns, requiring drug companies to alter packaging, and allowing providers to write smaller prescriptions. In addition, the Centers for Disease Control and Prevention and now Blue Cross Blue Shield are actively advocating for a new standard that emphasizes non-opioid alternatives as the first line of treatment for pain management over opioid prescribing.

As the debate unfolds over the coming months, ASHT will continue to educate lawmakers about the important role hand therapists play in safe, effective pain management. ASHT will also be emphasizing the importance of non-opioid alternatives to pain management and working to improve and support policies that embrace the benefits of therapy and rehabilitation.

Stay tuned to ASHT's Legislative Action Center for updates on this issue.


Victory! Repeal Becomes Law

This morning, February 9th, President Trump signed the latest stopgap funding bill into law, which included the Permanent Repeal of the Medicare Therapy Cap!

Today marks a huge victory for the profession that was twenty years in the making.  As a member of the American Society of Hand Therapists, we wanted to thank you, sincerely, for your steadfast commitment to addressing this critical issue. You have lent your voice to this cause many times, and today, your emails and phone call were finally heard. Today, we can finally say, “The Medicare Therapy Cap is repealed!”

As we look to the future, we recognize that this victory is one part of a larger journey to ensure people have access to therapy services and ultimately a chance at functioning fully.  We must now look to continue seeking improvements through the rulemaking and implementation phases of this permanent repeal.  Your voice will be vital to this process as we find the best path forward for the profession.

Thank you for all of your support and congratulations on a job well done!

Click here for therapy cap frequently asked questions. 


February 7, 2018

Medicare Therapy Cap Repeal Within Reach

Swift action in the House of Representatives this week has brought full and permanent repeal of Medicare’s outpatient therapy cap one giant step closer to reality. Since 1997, ASHT and its allies in the therapy community have fought long and hard to repeal this harmful and arbitrary cap on Medicare beneficiary care. Our chance for victory is now!

On Monday evening, House negotiators unveiled a spending package aimed at avoiding another government shutdown and quickly readied it for consideration. The measure would extend government funding at current levels through March 23rd and address a slate of expired Medicare ‘extender’ policies, including a permanent solution to Medicare’s outpatient therapy cap. Following debate yesterday afternoon, the House passed the bill last night by a margin of 245-182.

In addition to immediately repealing the therapy cap, the language codifies the targeted review mechanism as well as the use of the KX modifier after a threshold of $3,000. In exchange for these changes and the corresponding costs associated with repealing the cap, negotiators included an offset that would reduce payment for therapy assistant (OTA and PTA) services beginning in 2022 to 85% of what is currently reimbursed. In the remaining time before the Senate considers its version, ASHT will work with its allies in the therapy community to advocate for an alternative offset.

With the Senate poised to make changes, it’s critical your Senators hear from you today. We need your help to ensure this giant step forward in the House is indeed a path to victory. Please contact your senators today and urge them to permanently repeal the therapy cap.

Be heard: Visit the ASHT Legislative Action Center


January 24, 2018

After a weekend of wrangling, the House and Senate reconvened this past Monday and agreed to end its shutdown stalemate.  Ultimately, Congress approved an amended continuing resolution (CR) that reopened the government and extended funding through Feb. 8th. The agreement also reauthorized and funded the popular Children's Health Insurance Program (CHIP) for six-years and delayed a number of ACA-related tax provisions imposed on medical devices, high-cost health plans, and health insurers.

Despite progress, Congress faces a lengthy to-do list in the coming weeks, including finding a long-term solution on FY2018 spending levels, reaching compromises on immigration, passing health insurance market stabilization measures, and, importantly, addressing expired Medicare extenders policies, like the outpatient therapy cap.

With some of our nation’s frailest seniors projected to hit the cap later this month and the Centers for Medicare and Medicaid Services (CMS) currently holding claims for physical, speech, and occupational therapy, we are quickly reaching an untenable situation. It’s critical that our voice resonate above the noise and negotiations of Washington, especially in the coming days. A bipartisan solution to permanently address the therapy cap exists, and ASHT strongly urges you to reach out to your Members of Congress and call on them to support a permanent solution today!

Be heard: Visit the ASHT Legislative Action Center. 


2017-2016 Active Legislative Updates from ASHT

December 1, 2017

The Pain Management Best Practices Inter-Agency Task Force was launched by Health and Human Services (HHS) in August 2017. This task force was mandated by the 2016 Comprehensive Addiction and Recovery Act and includes HHS, Departments of Defense and Veteran Affairs, Office of National Drug Control Policy and various other stakeholders. The task force’s main role is to determine gaps or inconsistencies in the best practices of pain management. Many healthcare providers have expressed concerns that questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which is tied to hospital reimbursement, could be leading to an increase of opioid prescriptions across the nation. In response to these concerns by healthcare providers, starting October 1, 2017, the Centers for Medicare and Medicaid Services (CMS) will no longer link the HCAHPS pain management scores to hospital payment, which is under the Hospital Value-Based Purchasing Program. To also combat the opioid epidemic, the Center for Disease Control (CDC) has released guidelines for prescribing opioids and an Rx Awareness Campaign to increase awareness of the risks of inappropriate opioid use. 

For more information about this post click here.

For more information about HCAHPS click here.


November 6, 2017

Legislative Alert - Bipartisan Medicare Cap

PROGRESS FOR THERAPY CAP

Progress could be on the horizon for permanently repealing the Therapy Cap. On October 26, the three congressional committees responsible for Medicare outpatient therapy cap announced they had reached an agreement for a policy framework. This proposal would still have to undergo the legislative progress; however, the current draft calls for permanent repeal of the cap starting January 1, 2018, while continuing use of KX modifier, substantiation of medical necessity, as well as medical review once certain thresholds have been exceeded. The KX modifier will be required for all claims over the medicare cap (2017 CY Cap is $1,980; 2018 CY Cap value will be $2,010). All claims over $3,000 are subject to medical review through 2027. This threshold has been lowered from the initial threshold of $3,700; however, no additional funding has been assigned toward the review process.

The Advocacy Committee will keep members informed on any further developments.

ASHT encourages all members to continue to communicate with their congressmen regarding legislation causing reimbursement limitations on hand therapy practice through the Legislative Action Center (LAC).


September 28, 2017

AOTA’s Capitol Hill Day was held September 25, 2017 in Washington, DC. There were more than 600 participants representing 45 states and the District of Columbia present for this special Capitol Hill Day representing occupational therapy’s centennial year. This year, the following bills were points of discussion as occupational therapists met with their senators and representatives from all over the country.

Medicare Access to Rehabilitation Services Act (H.R.807/S.253)
If passed, this bill would provide a permanent solution to the Medicare Part B Outpatient Therapy Cap, which currently limits clients’ access in outpatient settings including nursing facilities, rehabilitation hospitals and clinics. The current therapy cap is $1,980 for occupational therapy services, and a combined $1,980 for physical therapy and speech therapy. This is a 20-year-old policy that significantly impacts outpatient therapy services, which limits timely and appropriate care for Medicare beneficiaries. Additionally, action must be taken prior to the end of the year because the current “exceptions process” to the “hard therapy cap” expires at the end of the calendar year.

Medicare Home Health Flexibility Act (S.977)
Currently under Medicare, occupational therapists are not allowed to open home health cases and conduct the initial plan of care. In a home health setting, occupational therapists must wait for another discipline such as a physical therapist or speech therapist to conduct the initial visit before they are able to initiate occupational therapy services. Occupational therapists are qualified to provide these initial and comprehensive home assessments based on their training to assess the client including their functional capacities, their environment and their occupations. This policy would apply to rehabilitation cases only when skilled nursing is not ordered by the physician; therefore, nurses would continue to conduct the initial and comprehensive assessments whenever they are involved in home health cases. This bipartisan bill has a received a score of zero, indicating it has no cost and could even save Medicare beneficiaries money. AOTA, APTA, ASHA and National Association of Home Care and Hospice (NAHC) support this bill. The House bill should soon be introduced.

Support Full Funding for Title VII and VIII of the Health Resources and Service Administration
Title VII and VIII of the Health Resources and Services Administration (HRSA) are federally funded programs that support the expansion of health professional training to provide services to those in underserved areas. Title VII and VIII were developed to help prepare the next generation of health professionals to service the nation’s growing health needs and could include providing services in rural areas, children and families with low incomes, senior and veterans. The funding level for Title VII and VIII for 2017 was $580 million and senators and representatives were encouraged to keep the same level of funding ($580 million) for 2018 to continue these programs. Title VII provides funding to many programs that occupational therapists are eligible for, including Geriatric Education and Training, Allied Health Workforce Programs and Behavioral Health and Workforce Education and Training Program (BHWET). The BHWET program would help to provide behavioral health and mental health services to clients in underserved areas. Occupational therapists are included within the BHWET program, and this could help to expand fieldwork opportunities for student occupational therapists in behavioral health settings. The funding for the BHWET program was $50 million in 2017, and senators and representatives have been encouraged to help support this program at that current level of $50 million for the 2018 year. 

We encourage you to visit ASHT’s Legislative Action Center to contact your senators and representatives today. The Medicare Access to Rehabilitation Services Act summary is available, along with a template letter to send to your senators and representatives to ensure that this year we permanently remove the Medicare Part B Outpatient Therapy Cap!


June 28, 2017

Legislative Alert - Better Care Reconciliation Act Delay

Senator Mitch McConnell announced late yesterday the vote for repeal of the Affordable Health Care Act will not take place until after the Senate returns from the holiday on July 11. At least four Republican senators stated they would vote against a motion to begin the debate, leading the majority leader to postpone discussions and a vote.

Lobbyists are working hard to convince moderate Republicans to vote in favor of the bill. The delay allows Senator McConnell more time to engage in “horse trading” in order to secure the votes needed for passage.

If you have not yet gone to the Legislative Action Center to weigh in on this legislation, now is the time. Many of your colleagues have contacted their senators asking for specific changes to the legislation, but we need you to do the same. Log in and be heard today!


May 11, 2017

Legislative Alert - The American Health Care Act of 2017

On May 4, 2017, the House of Representatives passed the American Health Care Act of 2017 (AHCA) H.R.1628 by a vote of 217-213. 

This legislation impacts coverage for therapy services by allowing states to opt out of requiring the essential health benefits for both Medicaid and the individual market as required by the Affordable Care Act (ACA).

Another notable change affects individuals with pre-existing conditions. Individuals with pre-existing conditions must be offered health insurance, but there is no limit on the cost of that insurance. The bill includes $8 billion in supports to help lower premiums for these individuals.

The bill also permits states to apply a work requirement for non-disabled, non-elderly, non-pregnant adults in order to receive Medicaid.

To date, the legislation has not been introduced in the Senate, where it is expected to be modified.

More information


March 29, 2017

Legislative Alert - American Health Care Act Update

The American Health Care Act (AHCA) of 2017 H.R.1628 was the House Republican’s proposal to repeal and replace the Affordable Care Act and prohibit federal funding for Planned Parenthood. However, on March 24, 2017, the vote on the AHCA was withdrawn, rather than having the bill defeated on the House floor. The withdrawal occurred because of several reasons, including the House Freedom Caucus pledging to oppose the AHCA due to the group believing the bill keeps too much of current legislation from the Affordable Care Act intact. There was also great push back from industry groups like the American Medical Association (AMA) and the American Hospital Association (AHA), which have both spoken out against the legislation. There were also many Democrats opposed to the AHCA due to the changes it would have on healthcare coverage for many Americans.

The bottom line with how the AHCA would have affected you depends on income, how you receive your health insurance and your healthcare needs. For example, older individuals with a low-income and health insurance from an individual market could have expected their premiums to increase. Individuals who utilize Medicaid would have faced few benefits with higher out-of-pocket costs. Additionally, if you receive benefits through your employer, your employer would have the right to stop providing coverage, which would have been likely to occur because tax credits would be eliminated for employers. There also would have been tax breaks for individuals with higher incomes.

Because the AHCA bill was withdrawn Friday, it appears any proposed changes to the Affordable Care Act will have to go back to the drawing board.

The ASHT Practice Division will continue to follow and provide regular updates on legislation relative to hand rehabilitation. If you have not yet had chance, please check out the Legislative Action Center, which is an easy-to-use tool that provides sample position letters, phone scripts and tweets that can be personalized by you to reach you elected representatives!


October 26, 2016

Legislative Alert - Advocacy Committee Report

Orthotics & Prosthetics Legislation:

S.2312 DME Access and Stabilization Act.
-No change from previous report
-20 cosponsors

S.829/H.R.1530 Medicare Orthotics and Prosthetics Improvement Act of 2015
-No change from previous report 
-1 cosponsors

H.R.1526: Medicare Audit Improvement Act of 2015
-No change from previous report
-4 cosponsors

H.R.5210/S.2736: Patient Access to Durable Medical Equipment Act of 2016 and PADME Act
-No change from previous report
-35 cosponsors

Rehabilitation Legislation:

S.539/H.R.775: Medicare access to Rehabilitation Services Act
Purpose:
A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps.
Status: H.R.775: Introduced: Feb. 5, 2015; Sponsor: Charles Boustany Jr.; 237 cosponsors (132D, 104R, 1I)
S.539: Introduced: Feb. 24, 2105; Sponsor: Benjamin Cardin, 35 cosponsors (22D, 12R, 1I)
-H.R.775: Increased by 6 cosponsors
-S.539: Increased by 2 cosponsors

S.2409/H.R.4273: Medicare and Medicaid Improvements Act of 2015.
-No change from previous report
-S.2409: 2 cosponsors
-H.R.4273: 10 cosponsors

H.R.3727: Health Insurance Rate Review Act
Purpose:
To amend the Public Health Service Act to provide protections for consumers against excessive, unjustified or unfairly discriminatory increases in premium rates.
Status: Introduced: Oct. 8, 2015; Sponsor: Janice Schakowsky; 14 cosponsors (14D)
H.R.3727: Increased by 1 cosponsor

S.1849: Medicare Patient Empowerment Act
-No change from previous report
-6 cosponsors

H.R.3770 End surprise billing act of 2015
Purpose:
To amend title XVIII of the Social Security Act to prevent surprise billing practices, and for other purposes.
Status: Introduced: Oct. 20, 2015; Sponsor: Lloyd Doggett; 31 cosponsors (31D)
-H.R.3770: Increased by 5 cosponsors

S.800/H.R.1631/H.R.1469: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act
-No change from previous report*
-S.800: 7 cosponsors
-H.R.1631: 4 cosponsors
-H.R.1469: none

H.R.2646: Helping Families in Mental Health Crisis Act of 2015*
-No change from previous report
-H.R.2646: 207 cosponsors

Telehealth Legislation:

H.R.4155/S.2343 Telehealth Innovation & Improvement Act of 2015
-No change from previous report
-H.R.4155: 1 cosponsor
-S.2343: 1 cosponsor

H.R.2066 Telehealth Enhancement Act of 2015
-No change from previous report
-6 cosponsors

H.R.2948: Medicare Telehealth Parity Act of 2015
Purpose:
This House bill seeks to amend title XVIII of the Social Security Act. Under Medicare, the bill would allow for a gradual expansion of telehealth coverage.
Status: Introduced: July 7, 2015; Sponsor: Mike Thompson; 67 cosponsors (43D, 24R)
-H.R.2948: Increase by 5 cosponsors

H.R.4442/S.2484: CONNECT for Health Act*
Purpose:
This bill amends titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program to use telehealth and remote patient monitoring services, and for other purposes.
Status: H.R.4442: Introduced Feb. 3, 2016; Sponsor: Diane Black; cosponsors: 32 (21D, 11R)
S.2484: Introduced Feb. 2, 16; Sponsor: Brian Schatz; cosponsors: 18 (9R, 9D)
-H.R.4442: Increase by 3 cosponsors
-S.2484: Increase by 8 cosponsors

Lymphedema Legislation:

H.R.1608/S2373: Lymphedema Treatment Act
Purpose:
These companion House and Senate bills were introduced to amend title XVIII of the Social Security Act since Congress acknowledged that Medicare beneficiaries currently lack coverage for compression therapy. The goal is for Medicare to cover specific lymphedema compression treatment items and supplies as coverage benefits under durable medical equipment.
Status: H.R.1608: Introduced: March 25, 2015; Sponsor: David Reichert; 249 cosponsors (140D, 109R); S.2373: Introduced Dec. 8, 2015, Sponsor: Maria Cantwell; 28 cosponsors (19D, 9R)
-H.R.1608: Increase by 12 cosponsors
-S.2373: Increase by 7 cosponsors


August 4, 2016

Legislative Alert - Presidential Candidate Positions on Healthcare

In an effort to keep our members informed, the Advocacy Committee has reviewed the presidential candidates’ healthcare positions. We will provide updated information when/if it becomes available. This information is current as of 8/4/2016.

Democratic Nominee:

Hillary Clinton’s Perspectives on Healthcare and the Impact on Hand Therapy Services

Information adapted from Hillary Clinton’s Website:

https://www.hillaryclinton.com/issues/health-care/ 

Hillary Clinton's key agenda items that may touch upon hand therapy services:

  • "Defend and expand the Affordable Care Act." Secretary Clinton believes that expanding affordable coverage is necessary to provide services while decreasing costs. She states she will defend the Affordable Care Act (ACA), which may directly affect coverage of hand therapy and other rehabilitation services.
    • Impact on hand therapy: This policy could increase access to hand therapy services. With more Americans insured, this could help stabilize healthcare costs.
  • "Lower out-of-pocket costs like co-pays and deductibles.” the secretary believes this will help make services affordable.
    • Impact on hand therapy: These policies may influence affordability of hand therapy services for both individuals and families.
  • "Support new incentives to encourage all states to expand Medicaid.” According to Secretary Clinton, incentivizing states to help provide and expand Medicaid will help serve individuals who do not have access to services.
    • Impact on hand therapy: These policies could influence the number of insured clients seeking hand therapy services. Many individuals who previously did not have Medicaid coverage would now be covered.
  • "Expand access to affordable healthcare to families regardless of immigration status." Secretary Clinton believes that individuals and families who want to purchase health insurance should be able to do so regardless of immigration status.
    • Impact on hand therapy: These policies could influence the number of insured clients seeking hand therapy services. Many individuals who previously were not eligible to purchase coverage would now be covered. 
  • "Expand access to rural Americans, who often have difficulty finding quality, affordable healthcare." Secretary Clinton will take steps to expand telehealth reimbursement under Medicare and other programs in rural areas.
    • Impact on hand therapy: This could encourage passage of pending legislation designed to expand the eligibility of hand therapists to provide telehealth services and improve patient access to rural hand therapy services.

Republican Nominee:

Donald Trump’s Perspectives on Healthcare and the Impact on Hand Therapy Services

Information adapted from Donald Trump’s Website:

 https://www.donaldjtrump.com/positions/healthcare-reform

 https://www.donaldjtrump.com/positions/veterans-administration-reforms   

Donald Trump’s key agenda items that may touch upon hand therapy services:

  • Repeal the Affordable Care Act. A repeal of the Affordable Care Act would lift the legal requirement for all Americans to purchase health insurance and would return free market competition to the health insurance industry.
    • Impact on hand therapy: This policy could impact access to hand therapy services for uninsured clients.  For clients with insurance, free market competition could influence cost of coverage and subsequently the affordability of hand therapy services. Increased competition could bring down copayments or it could work in the reverse and plans could restrict visits or omit coverage altogether.  Insurers could do this directly within the health plan or indirectly by applying large copayments for therapy services.
  • Offer tax deductions on health insurance premiums. Allow Health Savings Accounts (HSA) for individuals.  HSAs provide tax-free payment options. Candidate Trump proposes that HSAs be allowed to accumulate value overtime, to be inherited as part of an estate without penalty, as well as to be used to cover any family member’s health expenses without penalty.
    • Impact on hand therapy: These policies may influence affordability of hand therapy services for both individuals and families.
  • Require price transparency from healthcare providers.
    • Impact on hand therapy: These policies would allow clients to have a better understanding of the costs associated with hand therapy services and allow them to “comparison shop” for providers.
  • Propose Medicaid Block Grants. Incentives would be offered to states that identify and eliminate Medicaid waste, fraud and abuse.
    • Impact on hand therapy: This policy may influence the stringency of Medicaid’s regulations and influence reimbursement for hand therapy services.
  • Allow eligible veterans access to any physician that accepts Medicare.
    • Impact on hand therapy: This policy may improve access for hand therapy services provided to veterans.
  • Create satellite VA clinics in rural and underserved areas.
    • Impact on hand therapy:  This policy may increase demand for hand therapists and improve access to hand therapy services in rural and underserved areas for veterans.

July 13, 2016

Legislative Alert - Active Legislative Update

Orthotics & Prosthetics Legislation:

S.2312 DME Access and Stabilization Act
-No change from previous report

S.829/H.R.1530 Medicare Orthotics and Prosthetics Improvement Act of 2015
-No change from previous report

H.R.1526: Medicare Audit Improvement Act of 2015
-No change from previous report

H.R.5210/S.2736: Patient Access to Durable Medical Equipment Act of 2016 and PADME Act
Purpose
: To improve access to durable medical equipment for Medicare beneficiaries under the Medicare program, and for other purposes.
Status: H.R.5210: Introduced to the House of Representatives 5/12/16, passed House 7/5/16; Sponsor: Tom Price; Cosponsors: 121 cosponsors (102R, 19D)
S.2736: Status: Introduced to Senate 3/17/16, passed Senate 6/21/16; Sponsor: John Thune; Cosponsors: 35 (22R, 12D, 1I)

Rehabilitation Legislation:

S.539/H.R.775: Medicare access to Rehabilitation Services Act
Purpose:
A bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps.
Status: H.R.775: Introduced: 2/5/15; Sponsor: Charles Boustany Jr; 231 cosponsors (128D, 102R, 1I)
S 539: Introduced: 2/24/15; Sponsor: Benjamin Cardin, 33 cosponsors (21D, 11R, 1I)

S.2409/H.R.4273: Medicare and Medicaid Improvements Act of 2015
Purpose:
To amend titles XVIII and XIX of the Social Security Act to improve payments for hospital outpatient department services and complex rehabilitation technology and to improve program integrity, and for other purposes.
Status: S.2409: Introduced: 12/16/15; Sponsor: Ron Wyden; 2 cosponsors (2D)
H.R.4273: Introduced 12/16/15; Sponsor: Gene Green; 10 cosponsors (10D)

H.R.3727: Health Insurance Rate Review Act
-No change from previous report

S.1849: Medicare Patient Empowerment Act
-No change from previous report

H.R.3770 End surprise billing act of 2015
-No change from previous report

S.800: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act
-No change from previous report

H.R. Helping Families in Mental Health Crisis Act of 2015
Purpose:
To ensure the availability of psychiatric, psychological and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes.
Status: Introduced 6/4/15, passed house 7/6/16; Sponsor: Tim Murphy, cosponsors: 207 (147R, 60D)

Telehealth Legislation:

H.R.4155/S.2343 Telehealth Innovation & Improvement Act of 2015
-No change from previous report

H.R.2066 Telehealth Enhancement Act of 2015
-No change from previous report

H.R.2948: Medicare Telehealth Parity Act of 2015
Purpose:
This House bill seeks to amend title XVIII of the Social Security Act. Under Medicare, the bill would allow for a gradual expansion of telehealth coverage.
Status: Introduced: 7/7/15; Sponsor: Mike Thompson; 62 cosponsors (42D, 20R)

H.R.4442/S.2484: CONNECT for Health Act
Purpose:
This bill amends titles XVIII and XI of the Social Security Act to promote cost savings and quality care under the Medicare program to use telehealth and remote patient monitoring services, and for other purposes.
Status: H.R.4442: Introduced 2/3/16; Sponsor: Diane Black; cosponsors: 29 (19D, 10R)
S.2484: Introduced 2/2/16; Sponsor: Brian Schatz; cosponsors: 10 (5R, 5D)

Lymphedema Legislation:

H.R.1608/S.2373: Lymphedema Treatment Act
Purpose:
These companion House and Senate bills were introduced to amend title XVIII of the Social Security Act since Congress acknowledged that Medicare beneficiaries currently lack coverage for compression therapy. The goal is for Medicare to cover specific lymphedema compression treatment items and supplies as coverage benefits under durable medical equipment.
Status: H.R.1608: Introduced: 3/25/15; Sponsor: David Reichert; 237 cosponsors (135D, 102R); S2373: Introduced 12/8/15, Sponsor: Maria Cantwell; 21 cosponsors (15 D, 6 R)


June 1, 2016

Legislative Alert - Legislation Cosponsor Updates 

H.R.775: 228 cosponsors
S.539:    33 cosponsors

H.R.1528: 34 cosponsors

H.R.2948: 56 cosponsors

H.R.1608: 227 cosponsors
S.2373: 18 cosponsors


April 29, 2016

Legislative Alert - H.R.1526: Medicare Audit Improvement Act of 2015

This legislation amends the Medicare portion of the Social Security Act to modify payment policies in the Medicare program for DMEPOS:

  • All records of an orthotist or prosthetist who furnishes a prosthesis or orthosis to a Medicare beneficiary are considered part of the medical record to determine if the device is medically necessary
  • Medicare can deny payment if the supplier does not meet requirements for licensing or accreditation by a national board
  • Authorizes MAC and RAC review for supplier license or accreditation for DME     
  • Payments that have been made to those who do not meet O & P national board requirements will be recouped. RAC can review claims dating back four years
  • Patients are not liable for payment if the device is determined not reasonable or medically necessary
  • DOES NOT directly address those DME supplies provided by OTs, PTs, or physicians
  • DOES NOT apply to off-the-shelf orthoses
  • Directs the Secretary of HHS to review utilization of orthotics and prosthetics and develop utilization review criteria if necessary

Why this bill matters to hand therapists
This bill does not specifically include an exception to the orthotist licensing or accreditation requirement for therapists.

What you can do
Therapists residing in North Carolina should contact Representative Mark Meadows' office to explain the omission and urge him to include an exception in the bill for therapists. 

1024 Longworth HOB
Washington, DC 20515
Phone: (202) 225-6401
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April 20, 2016

Legislative Alert - H.R. 775/S. 539: Medicare Access to Rehabilitation Services Act of 2015

These bills, introduced in their respective chambers in February 2015 would repeal the Medicare Rehabilitation Caps. To date, there are 225 bipartisan cosponsors in the House of Representatives and 32 bipartisan cosponsors in the Senate. On the House side, the bill has been assigned to the House Energy and Commerce Committee, which sent it to the Health Subcommittee, chaired by Rep. Joseph Pitts (Pennsylvania) and also to the House Ways and Means Committee Health Subcommittee, chaired by Rep. Patrick Tiberi (Ohio). On the Senate side, the bill is stuck in the Senate Finance Committee, chaired by Sen. Orrin Hatch (Utah). The respective committee chairs have the power to decide whether or not a bill is read and acted on by the committee. Both bills have been stalled for more than a year. A bill must be reported on by the committee before it can reach either chamber for a vote.

Despite both bills having the majority of bipartisan support, the respective committee chairs have not allowed action on these bills.

What this means for hand rehabilitation: Repeal of the Cap would remove the artificial restriction on Medically Necessary Rehabilitation Services and remove the burden from therapy providers of tracking the cap, initiating the exceptions process and facing manual medical review of claims exceeding $3,700. This also reduces stress on Medicare beneficiaries who often discontinue their therapy after reaching the cap for fear they will face large out-of-pocket costs if they continue or who put off surgery until the beginning of the calendar year in order to make sure they have enough therapy visits for post-surgical rehabilitation.

What you can do:  If you live in Ohio, Pennsylvania or Utah, please contact the committee chairman and let them know this legislation is important to you and your patients and should have the opportunity to reach the floor for a vote.  You can check to see if your congressperson or senators have signed on to cosponsor this legislation. (Scroll down to the Details section of the page where the cosponsors are listed.) If your legislators have signed on, tweet or email to thank them; if they haven’t, send a tweet or email asking for their support of this legislation or schedule a visit with their local office to find out why they are hesitant to support the legislation. Please send any feedback you receive to asht@asht.org.


April 20, 2016

Legislative Alert - S. 800: Enhancing the Stature and Visibility of Medical Rehabilitation Research at the NIH Act

3/19/2015—Introduced in Senate

2/9/2016-Status: Sent to Senate floor to be voted on as part of a larger medical innovation package that hopes to join with legislation passed in the House.

This bill amends the Public Health Service Act to revise requirements for medical rehabilitation research.

The purpose of the National Center for Medical Rehabilitation Research (NCMRR) is revised to include coordination of research and research training.

The NCMRR must develop and periodically update a comprehensive research plan for medical rehabilitation research. Currently, this research plan is developed and updated by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The NCMRR must: (1) annually report on progress in achieving the objectives, benchmarks and guiding principles described in the research plan; and (2) develop guidelines governing the funding for medical rehabilitation research by the National Institutes of Health.

The Medical Rehabilitation Coordinating Committee must periodically host a scientific conference or workshop on medical rehabilitation research.

The Department of Health and Human Services must enter into interagency agreements to coordinate medical rehabilitation research.

More information about NIH MRCC comprehensive plan to support rehabilitation research can be found here.

What does this mean for therapists?

Help to improve the lives of people with disabilities and chronic conditions by enhancing medical research completed at NIH, and in doing so, this could improve the provision of rehabilitation services and devices.


February 19, 2016

Legislative Alert - Adapted summaries of bills: H.R.4155/ S.2343 Telehealth Innovation & Improvement Act of 2015; H.R.2066 Telehealth Enhancement Act of 2015; H.R.2948 Medicare Telehealth Parity Act of 2015, and; H.R.1608/S2373 Lymphedema Treatment Act

H.R.4155/ S.2343 Telehealth Innovation & Improvement Act of 2015
H.R.4155
: House Sponsor: Rep Diane Black [R-TN6]
Cosponsors as of February 14, 2016: NONE
Introduced: December 2, 2015
Referred to House Subcommittee: December 4, 2015
Status: Referred to Subcommittee on Health

S.2343: Senate Sponsor: Cory Gardner [R - CO4]
Cosponsors as of February 14, 2016: 1
Referred to Senate Committee: December 2, 2015
Status: Read twice and referred to the Committee on Finance

Summary: These companion bills will require the Center for Medicare and Medicaid Innovation to test the effect of telehealth services in Medicare healthcare delivery reform models for cost, effectiveness and improvement in quality of care without increased cost of delivery. The bill would expand Medicare coverage to telemedicine services in rural areas and allow those hospitals to evaluate the benefits of telehealth services.

Why is this bill important for hand therapists?
Giving the Center for Medicare and Medicaid Innovation and rural hospitals the ability to evaluate and test the impact of telehealth services may create an opportunity for expansion of future coverage for Medicare beneficiaries in hand therapy practices.

H.R.2066 Telehealth Enhancement Act of 2015
House Sponsor: Rep. Gregg Harper [R-MS3]
Cosponsors as of February 14, 2016: 6
Introduced: April 28, 2015
Referred to House Subcommittee: May 1, 2015
Status: Referred to the Subcommittee on Health

Summary: This bill was introduced for the purpose of expanding and promoting how telehealth is applied under Medicare and additional federal healthcare programs, as well as other purposes. Coverage would include (but not be limited to):

  1. Increasing hospital payments with better-than-expected outcomes
  2. Intertwining telehealth and remote patient monitoring into plans similar to Medicare Advantage and supplemental coverage
  3. Bundling payments for telehealth services and remote patient monitoring
  4. Including critical access hospitals, sole community hospitals, home telehealth sites, etc. as originating sites for telecommunication systems for eligible telehealth individuals
  5. Specifying that universal telecommunication service support must be provided to additional healthcare providers including occupational therapists and physical therapists.
  6. Enhancing healthcare provider access to advanced telecommunication and information services, disregarding provider location.

Why is this bill important for hand therapists?
Since this bill has multiple coverage and payment benefits, hand therapy practices would receive increased coverage benefits for clients and patients who receive telehealth services. The more telehealth is promoted within healthcare programs on the federal level, the more care options are available to Medicare beneficiaries.
 

H.R.2948: Medicare Telehealth Parity Act of 2015
House Sponsor: Rep. Mike Thompson [D-CA5]
Cosponsors as of February 14, 2016: 27
Introduced: July 7, 2015
Referred to House Subcommittee: July 10, 2015
Status: Referred to the Subcommittee on Health

Summary: This House bill seeks to amend title XVIII of the Social Security Act. Under Medicare, the bill would allow for a gradual expansion of telehealth coverage. Coverage expansion would include (but not be limited to):

  1. Expanding telehealth coverage in three phases
  2. Extending "originating site" for telehealth service payment to any federally qualified health center and any rural health clinic (with eligible telehealth individual is located at time of service via telecommunication system.)
  3. Authorizing additional telehealth providers to include occupational therapists and physical therapists
  4. Extending coverage of Medicare to remote patient management services for certain chronic health conditions

Why is this bill important for hand therapists?
Telehealth expansion will increase the ability for healthcare practitioners to offer increased services to their Medicare clients and/or patients. Occupational and physical therapists would be authorized providers for telehealth, which inevitably expands reimbursement for hand therapy services, especially in rural health clinics and for certain chronic health conditions.
 

H.R.1608/S2373: Lymphedema Treatment Act
H.R.1608
: House Sponsor: Rep. David Reichert [R - WA8]
Cosponsors as of February 14, 2016: 188
Introduced: March 25, 2015
Referred to House Subcommittee: March 27, 2015
Status: Referred to the Subcommittee on Health

S.2373: Senate Sponsor: Maria Cantwell [D - WA]
Cosponsors as of February 14, 2016: 10
Referred to Senate Committee: December 8, 2015
Status: Read twice and referred to the Committee on Finance

Summary: These companion House and Senate bills were introduced to amend title XVIII of the Social Security Act since Congress acknowledged that Medicare beneficiaries currently lack coverage for compression therapy. The goal is for Medicare to cover specific lymphedema compression treatment items and supplies as coverage benefits under durable medical equipment. Covered treatment items (as prescribed by a physician, physician assistance, nurse practitioner or clinical nurse specialist) are as follows: multilayer compression bandaging systems, custom or standard fit gradient compression garments, non-elastic and low elastic compression garments and compression wraps and directional flow pads and any other compression garments, bandaging systems, devices and aids determined to be effective in the prevention or treatment of lymphedema.

Why is this bill important to hand therapists?
Medicare coverage of certain compression treatment items and supplies will impact reimbursement for hand therapy practitioners. These expanded items will be able to be billable under durable medical equipment for any Medicare beneficiary receiving lymphedema hand therapy services.

Summaries Adapted From:
www.govtrack.us and
http://thomas.loc.gov/home/bills_res.html (The Library of Congress)


February 12, 2016

Legislative Alert - H.R. 3762: Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015

Feb 2, 2016 —The President vetoed this bill (1/8/2016). Congress then attempted to override the President’s veto. A vote to override the President’s veto failed in the House. This bill is now dead.

This bill would have repealed key parts of Obamacare including:

  • Restricted the federal government from operating healthcare exchanges
  • Phased out funding for subsidies to help lower- and middle-income individuals afford insurance through the healthcare exchanges
  • Eliminated tax penalties for individuals who do not purchase health insurance and employers with 50 or more employees who do not provide insurance plans
  • Eliminated taxes on medical devices and the so-called “Cadillac tax” on the most expensive healthcare plans
  • Phased out an expansion of Medicaid over a two-year period
  • Ended federal funding for Planned Parenthood

February 12, 2016

Legislative Alert - H.R. 105: Quality Health Care Coalition Act of 2015

1/6/2015 — Introduced in House.

Exempt healthcare professionals, including individuals and entities, from federal and state antitrust laws in connection with negotiations with a health plan regarding contract terms under which the professionals provide healthcare items or services for which plan benefits are provided.

This act (1) applies only to healthcare professionals excluded from the National Labor Relations Act; and (2) does not apply to negotiations relating to Medicare or Medicaid programs, the Children's Health Insurance Program, medical and dental care for members of the uniformed services, veterans' medical care, the federal employees health benefits program or the Indian Health Care Improvement Act.

How does this bill impact hand therapists?
Therapists will be allowed to legally negotiate reimbursement rates as a group, whereas now, it is a violation of anti-trust laws.


February 2, 2016

Decision 2016: The race is officially on following the Iowa Caucus. The most exciting fact to come out of the February 1 event was the record turnout by Iowa voters from both parties. If you have never participated in a caucus or primary, this is a year when every vote counts. The candidates have strong, differing viewpoints about the future of healthcare in this country. Your participation will help determine the future of our profession!