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Visiting with Your Legislators

Heather ParsonsDirector of Federal Advocacy

Tim CaseyDirector of Federal Affairs

Tips for the Day

Wear comfortable shoes. You may be doing a lot of walking! Be prepared to go through metal detectors and security lines. The schedule is unpredictable. You may have to wait through

no fault of the Member of Congress or their staff. Keep the contact information for the offices your are visiting

with you. Should you be delayed, call the office and let them know.

If in a large group – identify speakers for your group

Things that May Surprise You

Youthful Staffers Meeting Location

Meeting space is limited Nontraditional locations (hallway, cafeteria)

Meeting Length 15-20 minutes Important to be clear and concise

Meeting Pointers

Introductions Introduce yourself – your training/practice program Provide quick overview of OT

Key Legislative Issues

Choose 2-3 issues to discuss, you will not be able to cover all four

Conclusion Thank them for their time Ask them what would be the best way to follow up with them

Meeting Pointers

Avoid medical jargon or acronyms Congressional staff have multiple responsibilities Familiarity with our issues may vary

Be an honest broker Your credibility is EVERYTHING It’s okay if you don’t know the answer; Tell them you

will get back to them; Relay the question to AOTA staff and we will be sure to get back to them.

Meeting Pointers

Advocacy Packets Serve as a framework for your meetings Hand staff the information from the packets Discuss the issues included

Packets Include “One-pagers” on each of the issues to be discussed A Fact sheet and brochure about OT Information on “OT as part of the Health Care Solution”

Meeting Pointers

Be respectful of the staffers time Offer yourself as a resource Leave your packet with the staff Ask when and how to follow up with them Ask them for business card for follow up

What else is going on? Environment on Capitol Hill

Government Shutdown on October 1st??? Funding for the Federal Government needs to renewed

by September 30th or the government will shut down What is the fight about?

Fight over spending levels Fight over funding Obamacare Fight over raising the debt ceiling (or the ability to

borrow money to pay debts)

Medicare Outpatient Rehabilitation Therapy Cap

Therapy Caps… brought to you by the Balanced Budget Act of 1997

Congress acts to avoid harmful policyMoratoriumExceptions process

State of Play on the Cap

Fiscal Cliff Deal Extended the Medicare therapy cap exceptions

process until December 31, 2013. The automatic exceptions process applies when

patients reach the $1,900 threshold The manual medical review process continued at

the $3,700 threshold. Increased Multiple Procedure Payment Reductions

Medicare Access to Rehabilitation Services Act

HR 713/ S 367The Medicare Access to Rehabilitation Services Act - Repeals Medicare’s outpatient rehabilitation therapy cap.

Enjoys strong bipartisan support Senate Champions: Senator Ben Cardin (D-MD) & Senator Susan Collins (R-ME)

- 24 Co-Sponsors House Champions: Congressman Jim Gerlach (R-PA) and Xavier Becerra (D-CA)

- 127 Co-Sponsors

Hurdles to Passage $$$ Continuing concern about overutilization of therapy services

Reforming the Medicare Physician Fee Schedule and

Repealing Sustainable Growth Rate

NOT sustainable and has to be fixed every year. Historically the CAP is fixed at the same time as

the SGR. Momentum for long term solution strong Address Caps in any legislation reforming the

Medicare Physician Fee Schedule

House E&C Committee Passed Medicare Payment

ReformThe legislation passed unanimously out of Committee

The bill has four elements we must pay attention to: Payment for quality/outcomes Payment for efficiency of services Payment for quality improvement (including adopting evidence-based

practices) Alternative Payment Models (i.e. Non-Fee for Service Models such as Medical

Homes and ACOs) Even if this bill isn’t signed into law it is clear: this is the direction of

health care

Supporting Rehabilitation Research

National Center on Medical Rehabilitation Research (NCMRR)

Blue Ribbon Panel convened in 2011 Panel issued Recommendations in December 2012 NIH considering the recommendations and its

authority to implement them independently

Support Rehabilitation Improvement Act of 2013

(S. 1027)

Introduced by Senators Mark Kirk (R-IL) and Tim Johnson (D-SD)

The bill would seek to:

Enhance Coordination Establish rehabilitation research priorities Require feasibility report for all recommendationAdvancing Rehab Research without Authorizing new funding

Seeking Co-Sponsors in Senate and original Sponsors in the House

Ongoing Challenges for OT in Mental Health

Behavioral Health Specific Education Behavioral Health Specific Fieldwork Low Reimbursement Rates State Scope of Practice Barriers Lack of Public, Policy Maker Awareness

and Education on OT’s role

Current Hill Environment and Mental Health

• Recent mass shootings have brought the serious issue of severe, persistent mental illness into the national spotlight.

• There is a new dialogue about the ways in which we as a country we are falling short on early diagnosis and adequate treatment for people with mental illness.

• Members of Congress who never thought about mental illness are now trying to find solutions – big and small.

OT in Mental Health Act – HR 1067

Introduced by Rep. Paul Tonko (D-NY) in the House.

This bill amends the National Health Service Corp to include Occupational Therapists under the definition of “behavioral and mental health professional” for the purposes of loan forgiveness.

OT fills an important niche in prevention of mental illness and promotion of mental health.

The percentage of the workforce entering mental health has declined.

OT in Mental Health Act – HR 1067

The bill will expand the number of OTs practicing mental health – and therefore the overall number of mental health providers in two ways: Because of loan forgiveness, more new therapists will choose

to enter jobs focused on mental illness, that traditionally pay less.

States often use federal statute when defining state reimbursement policies. Expansion of the definition = expanded opportunities in states that currently do not reimburse OT for mental health services.

Talking Point Tips

1) Only 3% of OTs work in mental health. This not a dramatic expansion of the loan program.

2) Other groups listed in the definition are either supportive or neutral of our efforts – (see letter from the Mental Health Liaison Group).

3) Use vignettes to make your point! Use school based examples or community based ones if possible. This is a great way to sell the profession!

4) We would like more cosponsors of the bill in the House. 5) We are seeking a Senate sponsor and hope to have one soon. Seek

support for a bill “should it be introduced” or find out if the office would be interested in introducing a bill.

Mental Health Liaison Group letter of support

The other professions currently eligible for loan forgiveness as mental and behavioral health professionals either openly support our inclusion or have agreed to remain silent.

This support is very rare, but other professions understand the unique role of OT in helping people with mental illness.

Education Funding - Sequestration

Sequestration was a series of automatic spending cuts that were put into place in 2013 after Congress was unable to reach an agreement on how to reduce the federal deficit by $1.2 trillion.

Under sequestration both Title I (general education) and IDEA funding was cut by 5.1% for 2013.

There is a strong likelihood that these cuts will continue into 2014, with the possibility that they could be increased another 2.1%. (Total cut of 7.2% from 2012 to 2014).

The effect of these cuts on occupational therapy will vary from state to state, school district to school district: Has the state or district planned for these cuts

already? What is the local and state economy like? Has

the housing market (and tax base) begun to rebound?

How committed is your district to Special Education and related services like occupational therapy – is it a priority?

Education Funding Issues: Cuts to IDEA

Cuts are going to happen IDEA services including occupational therapy, are required by law.

We are advocating that Congress role back cuts to education. In your discussion you should:

Discuss the value of your work with individual students and the school as a whole;

Discuss the importance of special education services for student’s with disabilities.

Education Funding Issues: Cuts to IDEA

Taking your message to Capitol Hill

Make it personal YOU are Occupational Therapy’s best advocate Connect with your legislators

Where did you train? Where do you practice? Why did you become an occupational therapy practicioner?

Convey the link between policy and your patients You are their constituents

Do your Homework

Take 15 minutes to learn a little bit about the offices you are visiting.

Use the Legislative Action Center to do some research1. Are they already a cosponsor of the legislation? Then thank

them!2. Visit their website to see if they highlight issues that can be

related back to occupational therapy or to establish common ground.

Using a Smartphone? Download the “Congress” app from the Sunlight Foundation.

Most Importantly…

YOU are the EXPERT Convey your passion for OT Express your concerns Have FUN!