ASHA Highlights from PSHA's Legislative Council

Posted 7/21/2006

The Spring 2006 meeting of the ASHA Legislative Council took place from March 23-26, 2006 in Washington, D.C.  Below is a summary of the meeting.  As always, we welcome your questions and comments!

Capitol Hill Visits 

On Friday March 24, Councilors visited the offices of the House Representatives and Senators.  We met with staff representatives and discussed legislation for Hearing Aid Assistance Tax Credit, SLP Medicare Outpatient Supplier Status, Medicare Outpatient Therapy Caps, and IDEA Funding.  Please continue to write your Senators and Representatives about these important issues.  Overall, we had a positive response.  Many House Representatives in PA are already co-sponsoring the legislation we discussed.  Senator Arlen Specter has also been active in co-sponsoring important health care legislation.

Ranking of Critical Issues 

In addition to the Capitol Hill visits, another primary objective of the Spring Legislative Council meeting was to identify critical issues within the professions of audiology and speech-language pathology.  Based on input from ASHA members, we identified reimbursement, marketing of the professions, and recruitment and retention as the most critical issues.  These rankings will be used in helping the Executive Board identify Focused Initiatives.  

Resolutions 

During the Spring 2006 meeting, the Legislative Council passed the following resolutions:

LC SLP-SLS 4-2006  Rescind LC SLP/SLS 12-2003 Speech Language Pathologists Training and Supervising Other Professionals in the Delivery of Service to Individuals with Swallowing and Feeding Disorders

LC 1-2006 Revise ASHA Bylaws and Policies Associated with the Bylaws re Committee Appointments

LC 2-2006 Amend Section 4.2.i of the ASHA Bylaws

LC 3-2006 Rescind the Current Legislative Council Special Rules and Adopt the Legislative Council Operational Procedures, and Immediately Adopt Revised Legislative Council Electronic Meeting Procedures

LC 5-2006 Amend Section 4.2.a.1 of the ASHA Bylaws

LC 6-2006 Authorize ASHA’s Executive Board to Determine on an Annual Basis Whether Contributions Will be Made to the American Speech Language Hearing Foundation

LC 7-2006 Amend the ASHA Bylaws to Provide for the Legislative Council (LC) Election of the LC Members on the GRPP Board

Posted  1/14/06
Congress Completes Passage of 2006 Spending Bills for Health & Education

As one of its last acts before a late adjournment, Congress passed the Labor, Health and Human Services, and Education Appropriations bill for fiscal year (FY) 2006.  In brief, discretionary spending in the bill for many programs is below last year’s level. The funding amounts noted below do not include the 1% across-the-board cut of all non-defense domestic discretionary programs that was included in the Department of Defense’s fiscal year 2006 appropriations bill. 

AUDIOLOGY DIRECT ACCESS
The conference report accompanying the bill contains language that would direct the Centers for Medicare and Medicaid Services (CMS) to provide Congress with “A determination as to the current legal authority to permit direct access to licensed audiologists under similar terms and conditions used by the Department of Veterans Affairs and the Office of Personnel Management.  A report shall be submitted to the House and Senate Appropriations Committees by April 2006.”  This essentially requires CMS to identify any statutory changes necessary to give audiologists direct access under Medicare.

EHDI
Roughly $10 million in 2006 funding will be provided for the Universal Newborn Hearing Screening program of the Maternal and Child Health Bureau.  The Early Hearing Detection and Intervention (EHDI) program in the Center for Disease Control and Prevention (CDC) is scheduled to receive $6.6 million next year.  With the 1% across-the-board cut, these programs are essentially level funded from 2005.

Because of this federal funding, state initiatives, and the concerted efforts of state EHDI programs, over 90% of all newborns are screened for hearing loss before they leave the hospital.  This is remarkable progress from 1999 when only about 20% of hospitals screened for newborn hearing loss.  ASHA is now working with congressional leaders, consumers and other provider groups to develop new federal legislation that would focus on early intervention and expansion of pediatric audiology programs.

EDUCATION
The Department of Education is funded at $56.5 billion, $299 million above the President’s request and $59 million below last year’s level.   This funding level ends the historical growth in federal education spending.  IDEA Part B, State Education Grants are funded at $10.7 billion, $100 million above FY 2005, the smallest increase in a decade, forcing a backwards step from 18.6 percent to 18.0 percent in the federal commitment to fully fund special education.

In the No Child Left Behind program, Title I grants to states total funding is $12.8 billion, an increase of $100 million or less than 1% over FY 2005, the smallest increase in 8 years and $503 million less than the President’s request.  Early Reading First and Reading First programs are level funded at $104 million and $1 billion respectively, the same as the President’s request.

NIH
The National Institutes for Health (NIH) will receive $28.6 billion in funding in FY 2006 - a 1% increase over FY 2005 funding levels.  The National Institute on Deafness and Other Communication Disorders (NIDCD) received a similar increase.  Again, this program will essentially be level funded from 2005 with the 1% across-the-board cut to all non-defense discretionary programs. 

Posted 1/14/06
Key SLP Issues Included in Deficit Reduction Package

In a flurry of last minute action before their end of the year adjournment, Congress took action on several important issues to speech-language pathologists, including the therapy caps and 75% rule. But due to minor differences in the House and Senate passed versions of the Deficit Reduction Act of 2005 (DRA), it is unclear if the legislation will become law by year’s end.

The DRA avoids a 4.4% cut in the annual update to the 2006 Medicare fee schedule that otherwise would have taken effect on January 1. Most SLP procedures would receive the same payment in 2006 as they had in 2005.

Medicare outpatient therapy caps would be implemented in 2006 with an exceptions process allowing Medicare patients to receive medically necessary services beyond the financial limitation of $1740. If a determination by the Centers for Medicare and Medicaid Services (CMS) is not made within 10 business days of receipt of the request to provide services over $1740, then the therapy services are deemed to be medically necessary and the cap may be exceeded.

There are still many questions on how and when this new exceptions process would be implemented. However, CMS would be allowed to implement procedures for exceeding the cap through instructions to its contractors, rather than a formal rulemaking process.

The legislation additionally instructs CMS to implement code edits for outpatient therapy services to eliminate clinically illogical combinations of procedure codes and to control inappropriate billings, such a billing of speech-language pathology codes on a time-increment basis, rather than per procedure.

The value-based purchasing provisions in the original Senate bill were not included in the DRA. But several CMS pilot projects involving outcomes measures are funded under the legislation.

The DRA also extends the phase-in of the so-called "75% rule" for inpatient rehabilitation facilities (IRFs) over 3 years. The 75% rule allows CMS to disqualify a rehabilitation facility from participation in the Medicare program if, annually, less than 75% of its admitted patients (from the current 50%) do not fall within one of 13 diagnoses/conditions. Beginning on July 1, 2006, the determination rate would be set at 60%, and subsequently 65% in July 2007, and 75% in July 2008. 

Posted 10/29/05
ACTION REQUEST: Write a Letter to the Editor on Therapy Caps (in less than 5 minutes)
Medicare beneficiaries, once again, will face having their therapy benefits severely limited if Congress fails to take action by January 1, 2006. ASHA has been working intensely with key congressional committees and other therapy organizations to develop an alternative to the therapy caps that meets the fiscal constraints of the Medicare program.

We urgently need your help to spur Congress into action by writing a ‘letter to the editor’ in your local papers. In less than 5 minutes, you can send a letter to the editor by e-mail to your local papers based on your zip code. ASHA’s Take Action Web site now offers an editable, draft letter that conveys the very real and negative impact associated with the return of the therapy caps. Simply visit http://takeaction.asha.org, scroll down, and select “Write a Letter to the Editor on Therapy Caps: With A Small Investment Of Time, You Can Have An Impact.”

Posted 8/30/05
ASHA is aggressively working with Congress and other therapy organizations to develop a viable alternative to the therapy caps. The two-year moratorium on the caps is set to expire at the end of 2005. Without congressional intervention, speech-language pathology and physical therapy will again share a $1,750 financial limitation on Medicare Part B outpatient services for each beneficiary as of January 1, 2006.

ASHA’s goal in any new payment alternative is to:

· Recognize speech-language pathologists as suppliers under the Medicare program, thus allowing them to bill from a private practice;

· Allow for proper assessment and treatment of Medicare beneficiaries with complex needs in settings such as skilled nursing facilities; and

· Maintain speech-language pathology services as a separate Medicare benefit.

Please contact your Members of Congress immediately through ASHA’s Take Action Web site at http://www.asha.org/takeaction.htm and request that they support legislation that would:

· recognize speech-language pathologists as suppliers of Medicare services by separating SLPs and PTs in the outpatient Medicare statute; and

· repeal the therapy caps.

Posted 8/30/05
Beginning September, 1, 2005, active duty family members (ADFMs) who meet specific hearing-loss requirements will be eligible to receive hearing aids, including services and supplies, as a TRICARE benefit. This benefit is being implemented as part of the National Defense Authorization Act (NDAA) of 2002.  Previously, hearing aids and services were only available to those beneficiaries who were in the Program for Persons with Disabilities.  The new provision allows for coverage of a hearing aid to ADFMs diagnosed with a "profound" hearing loss.  TRICARE has established separate hearing-level thresholds for adults and children.  

For an adult to be eligible for hearing aids and services, the family member must have:

For a child of an active duty service member to be eligible for hearing aids and services, the child must have 26dB HL or greater hearing threshold level in one or both ears when tested in one of the following frequency ranges: 500, 1,000, 2,000, 3,000, or 4,000Hz.  

Posted:  8/26/05
Call for Caucuses at the Fall 2005 Meeting of the Legislative Council
The fall meeting of the Legislative Council (LC) will have dedicated times for Caucus Meetings. Although a request to hold a Caucus meeting must come from a member of the Legislative Council, Caucus meetings are open to all members of the Association

ASHA Member Procedure for Calling a Caucus

ASHA members interested in suggesting a topic/issue for a caucus meeting should contact their state Legislative Councilor(s). If you do not know who your Councilors are, please go to the ASHA Web site at http://www.asha.org/about/leadership-projects/LC for a complete roster.

Posted:  8/12/05
ASHA Submits Comments to ED on 2005 IDEA Proposed Rules
ASHA submitted a 21-page comment letter to the U.S. Department of Education (ED) addressing the proposed regulations for implementation of the Individuals with Disabilities Education Act (IDEA) 2004, specifically Parts B and D. The letter responded to ED’s June 21, 2005 Federal Register notice of proposed rulemaking (NPRM). ASHA expressed concern about a number of issues including: 1) qualification standards; 2) assistive technology; 3) specific learning disabilities; 4) evaluation, eligibility determinations of limited English proficient (LEP) students; and 5) early intervening services. ASHA members can access the full text of the letter at ASHA’s IDEA Information Center at http://www.asha.org/about/legislation-advocacy/federal/idea/.  Please visit http://takeaction.asha.org to access the model letter.

If you have questions on the ASHA Legislative Updates posted to the PSHA website, contact PSHA's Legislative Council, Craig Coleman, craig.coleman@chp.edu