Transcript Document
HOT TOPICS Michael Hurlbut Monica Herr Adnan Jalil Concussions Traumatic Brain Injury Post-Acute Care Reform Medicare Opt-Out Rehabilitation Research Direct Access Locum Tenens IDEA Health Care Reform Concussions • Advocacy surrounding national guidelines for concussion prevention, detection, and return to play • Protecting Student Athletes from Concussions Act (H.R. 3532) introduced by Congressmen Bishop (D-NY) and Miller (D-CA) • Includes PT in return to play decision making • Looking for a Senate companion bill • APTA work with CDC on Concussion guidelines • 2 PTs on CDC Mild Pediatric Traumatical Brain Injury Guideline Workgroup • Workgroup is supported by CONTACT Act (H.R. 3113/S.1516) to establish grants to carry out guidelines Medicare Opt-Out • Medicare Patient Empowerment Act of 2013 (H.R. 1310), • • • • introduced by Congressman Tom Price(R-GA) Would provide physical therapists and other healthcare providers with the ability to privately contract with Medicare beneficiaries Concern for patient access & affordability • H.R. 1310 allows beneficiaries to submit claims for reimbursement APTA supports Medicare private contracting for physical therapists Has been advocated for in larger healthcare vehicle (ex. SGR) Locum Tenens • Prevent Interruptions in Physical Therapy Act of 2013 (HR 3426), introduced by Congressmen Ben Ray Lujan (DNM) and Gus Biliraikis (R-FL) • Under a locum tenens arrangement a provider can bill and receive payment for a replacement provider’s services if a PT is out due to illness, pregnancy, vacation, or continuing medical education • Considered regulatory relief, technical fix • Advocacy efforts to include with SGR repeal or under suspension Traumatic Brain Injury • Traumatic Brain Injury Reauthorization Act (H.R. 1098) introduced by Reps. Bill Pascrell and Thomas Rooney • Reauthorizes funds through 2018 for Centers for Disease Control and Prevention (CDC) projects to reduce incidence of TBI and for TBI surveillance systems or registries • Reauthorizes grants to states for projects to improve access to rehabilitation and for protection and advocacy systems • National Traumatic Brain Injury Research and Treatment Improvement Act of 2014 (H.R. 4251) – Pascrell/Rooney • Directs CDC to evaluate existing data and monitoring collection systems that track incidence and circumstance of TBI and submit report to Congress • Establish a statistically sound, credible integrated surveillance system that would track the incidence and prevalence of TBI, as well as important demographic and other information to help analyze TBI Rehabilitation Research • Impact of NIH and the Economy • Why Does Rehabilitation Research Matter? • APTA Annual Research Fly-In • Blue Ribbon Panel Findings and Recommendations • Senators Mark Kirk (R-IL) and Tim Johnson (D-SD) Legislation (S.1027) • Congressional Efforts to Generate Interest in Rehabilitation Research • Disability Rehabilitation Research Coalition (DRRC) • Hearings, Congressional Briefings, Fly-Ins, Appropriations process, etc. IDEA • PTs who work in the school setting are bound by Individuals with Disabilities Educat Act (IDEA), to support the provision of public education for all children, regardless of disability • Hasn’t been reauthorized since 2004 • Education issues extremely political • Historically underfunded program • Federal Government commitment of 40% has never been met (usually around 15%) • Advocacy surrounding prevention from sequestration cuts • IDEA Full Funding Act annually introduced to provide the full 40% commitment to the program (H.R. 4136/S. 108) Post-Acute Care Reform • August, 2013: Senate Finance and House Ways and Means Committees asked for stakeholder input • APTA gave feedback on: • Quality • Assessment Tools • Value Based Purchasing • Reducing Hospital Readmissions • Bundled Payments • Site Neutral Payments • Alternatives to Fee-for-Service • PAC Settings have been a target for market basket cuts • PAC Reform has been discussed as an offset to SGR repeal Post-Acute Care Reform • IMPACT Act Discussion Draft • Requires standardized assessment data(quality and resource use measures) for PAC Settings • Requires standardized patient assessment data • Reports to Congress based on comparing patient outcome data to reform payment • May recommend bundles, site neutral payment in the future • First step in real reform • APTA will be providing feedback and working with Committees • Protecting Access to Medicare Act of 2014 (H.R. 4302) • Establishment of a new Value Based Purchasing (VBP) program for Skilled Nursing Facilities (SNF) based on performance on hospital readmission measures beginning in 2019. This new program would provide $2 billion in savings. Direct Access Direct Access Under Medicare – Recent Policy Victories 1. CMS Policy Changes in 2005 & 2008 2. 2010 Center for Medicare & Medicaid Innovation Direct Access Under FEHB Program • Overview • Advantages with FEHB • FEHB Reform Effort in Congress Next Steps… Health Care Reform • Repeal is main goal of House Repeal / Use ACA as a offset • Independent Payment Advisory Board APTA supports repeal of the “IPAB,” an independent board (with limited oversight) tasked with finding Medicare savings Bipartisan legislation (HR351/S351) exists to repeal • Public Spectacle Hearings held constantly reviewing ACA in the House • APTA Regulatory staff focused on implementation Exchanges / Marketplaces Network adequacy Grace period http://www.apta.org/HealthCareReform/MakingSense/ http://www.apta.org/Payment/Medicare/2014/Changes/