Visiting with Your Legislators

1. Visiting with Your Legislators Heather Parsons Director of Federal Advocacy Tim Casey Director of Federal Affairs

2. 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

3. 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

4. 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

5. 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.

6. 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”

7. 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

8. 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)

9. Medicare Outpatient Rehabilitation Therapy Cap • Therapy Caps… brought to you by the Balanced Budget Act of 1997 • Congress acts to avoid harmful policy Moratorium Exceptions process

10. 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

11. Medicare Access to Rehabilitation Services Act HR 713/ S 367 The 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

12. 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

13. House E&C Committee Passed Medicare Payment Reform The 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

14. 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

15. 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 recommendation Advancing Rehab Research without Authorizing new funding Seeking Co-Sponsors in Senate and original Sponsors in the House

16. 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

17. 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.

18. 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.

19. 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.

20. Talking Point Tips • Only 3% of OTs work in mental health. This not a dramatic expansion of the loan program. • Other groups listed in the definition are either supportive or neutral of our efforts – (see letter from the Mental Health Liaison Group). • 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! • We would like more cosponsors of the bill in the House. • 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.

21. 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.

22. 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).

23. Education Funding Issues: Cuts to IDEA • 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?

24. 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.

25. 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

26. 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 research • Are they already a cosponsor of the legislation? Then thank them! • 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.

27. Most Importantly… • YOU are the EXPERT • Convey your passion for OT • Express your concerns • Have FUN!