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AARC Legislative UpdateFederal and State

Regulatory ActivitiesOhio Society for Respiratory Care, Columbus, OH – September 28, 2009

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Federal Legislative and Regulatory

Update

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Medicare Respiratory Therapy Initiative – HR 1107 and S 343

Amends Medicare Part B to recognize respiratory therapy services as a separate benefit

HR 1107-House Sponsor Mike Ross (D-AK) 23 Co-Sponsors

S 343-Senate Sponsors Blanche Lincoln (D-AK) and Mike Crapo (R-ID) 8 Co-sponsors

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What It Does and Doesn’t Do

Adds RT services among other recognized medical and health care services, e.g., PAs, NPs

Permits RRTs with a bachelor’s degree to work under a physician’s “general” supervision

RRTs can provide services within their scope of work w/o physician being on site

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What It Does and Doesn’t Do It does not permit independent

practice RRTs cannot bill Medicare directly The physician bills Medicare and

receives the payment Payment is based on the same

formula used to pay physician assistants and nurse practitioners

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Why Not All RTs? Need to set an education level

consistent with other Part B providers

Need to keep costs minimal Need to keep it a small benefit Objective is to get “toe in the

door”

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What Are the Advantages? Opens opportunities for RTs to work

in a physician’s office Patients have greater access to RTs

Smoking cessation Disease Management Asthma Management MDI/DPI Device selection & patient

education

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What Are the Advantages? (cont.)

Physicians can be out of the office while the RT is furnishing a service

Physician’s payment is less than 100% of fee schedule BUT

It allows the physician to bill for two services while only performing one directly

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Support for RT Part B Initiative American College of Chest

Physicians National Association for Medical

Direction of Respiratory Care American Thoracic Society Alpha One Foundation COPD Coalition

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Medicare Oxygen Reform – HR 3220

Establishes a new Medicare home oxygen services benefit

Eliminates the 36-month CAP Keeps competitive bidding Creates a Home Oxygen Services

Advisory Committee (HOSAC) Mandates Certain Patient

Protections and Rights

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Medicare Oxygen Reform – HR 3220

Revamps how Medicare pays and views oxygen equipment

Stakeholders, DMEs, patients, Docs, RTs in coalition to hammer out acceptable details

AARC was instrumental in advocating for patient protections in the bill

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Medicare Oxygen Reform – HR 3220

Introduced by Ross before Aug. recess

Opposition from small and independent suppliers

Major compromises were recently negotiated

HME industry still at odds on interim payment policy

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Medicare Oxygen Reform – HR 3220

Likelihood of success is questionable Senate Finance wants to

eliminate 36-month cap reduce payments for stationary equipment increase payments for portable equipment propose $1 billion cut

Further cuts are needed to pay for eliminating the 36-month cap

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Quit Smoking for Life Act of 2009 HR 1850 and S 770

Creates specific smoking cessation counseling benefit – Medicare/Medicaid

Eliminates patient deductible Adds coverage of OTC smoking

cessation products if prescribed by physician

Establishes therapeutic class under Medicare Part D

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Family Smoking Prevention andTobacco Control Act – HR 1256

Signed into law by President Obama on June 22, 2009

AARC has been actively involved in tobacco control and smoking cessation for over 2 decades Part of Coalition that lobbied

Congress for passage

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Family Smoking Prevention andTobacco Control Act – HR 1256

Gives FDA authority to regulate marketing and promotion of tobacco products

Will set performance standards in order to protect public health

Phase-in of provisions between October 2009 and October 2012 FDA asked for public input

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Family Smoking Prevention andTobacco Control Act – HR 1256

AARC commented on the on-going activities of its Tobacco Roundtable Creation of pocket guides Teaching modules for RT educators

AARC stressed need for FDA to promote smoking cessation counseling

AARC offered to work with FDA on setting up web-based training

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Access to Frontline Health CareAct of 2009 – HR 2891

Creates a student loan repayment program

Graduate must agree to 2-year full-time service in health shortage areas

Interdisciplinary studies given preference

Frontline care services include respiratory therapy

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CDC Program Appropriations Request

COPD 4th leading cause of death Currently no targeted program at

CDC Congress asked to appropriate $1M

to CDC for a COPD Action Plan AARC partnered with US COPD Coalition Activated 435 Plan to gain support

CDC COPD “Czar” named to begin development of national plan

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PACT Representatives’ Success PACT reps are the cornerstone of

AARC success Annual D.C. Hill Lobby Day 2009: 103 RTs from 46 states and

DC Over 300 scheduled meetings Lobbied: RT Medicare Initiative, CDC

funding for COPD Joe Huff is Ohio’s representative

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National Health Care Reform Contentious debate – far from over Big Issues: public option; insurance

industry reform, mandated coverage, independent commission

Senate trying to gain bipartisan support

Too soon to know where it will all come out

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RT Initiative Not Part of HCR Each year Congress’ passes one big

bill Health Care reform is this year’s

“must pass” bill RT Initiative is a separate part that

gets tacked on to the larger piece – not part of the overall debate

AARC not involved in health care debate

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Pulmonary Rehab (PR) CMS has proposed coverage criteria

and payment for PR to implement new law

Limits coverage to patients with moderate to severe COPD

Sets payment through creation of a single new HCPCS Code

Only allows 36 sessions – billable as 1-hour per session

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PR Workgroup Advises CMS AARC was part of multi-society

workgroup to advise CMS on implementation

What were they thinking? -- the question we keep asking ourselves

Proposed policy is detrimental to patients Would deny access to many Would close most programs due to 78%

reduction in current payments

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AARC Comments on PR Must add “very severe” COPD to

criteria At minimum, include patients

covered now by local policies Scientific literature supports other

conditions Continue use of current G codes

0237-39

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AARC Comments on PR Permit separate billing for other

services Allow the physician to submit

appropriate E&M code Permit programs to be shaped based

on individual need Cap number of billable hours per day

at 3 or 4 – each hr. must have exercise component

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Other Strategies for PR Requested meeting with Deputy Sec.

of DHHS May engage Congress to write to CMS

insisting on changes to final rule Final rules expected in next couple of

months Program becomes effective January

1, 2010

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Definition of RT in CORFs Currently limits services to those of RRT AARC worked diligently with CMS to

change – misunderstood profession today New proposal reverts back to

longstanding policy Includes CRTs that are registry eligible or

have comparable experience/training

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Medicare Policy on Sleep Coverage

Policies on sleep testing in labs and at home don’t define “qualified” personnel

Local Coverage Decisions – some are more detailed policies

Some require only AASM accreditation, leaves Joint Commission out=monopoly

AASM personnel qualifications restrictive AARC working with CMS to urge changes

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State Legislative and Regulatory Update

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Economy Driving State Programs

Economic downturn severely impacting state budgets and demands on services

Lose job= lose employer health insurance

increase in Medicaid claims increase in unemployment claims Little room for expansion of services

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Overall State Legislative Picture Less legislation on disease management: COPD (CO & IL enacted), pulmonary,

asthma Some bills to track hospital acquired

infections: VAP Some expansion of smoking cessation

and prevention programs Many bills to increase tobacco taxes

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RT Licensure Law Changes

MN upgraded RT registration law (i.e., “title protection”) to full RT licensure law

HI came close to enacting a RT licensure law; will try again in 2010

FYI: Only Alaska and Hawaii do not regulate the RT profession

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Examples of State LegislationImpacting RT

NV exempt US military from RT licensure law

CT & KS to raise (significantly) RT licensure fees

GA - Tightens timeframe for temp licenses; also bill to permit the Lic. Bd. to require a mental or physical exam

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Examples of State LegislationImpacting RT (cont.) VT appropriations to support state

colleges with programs for health professionals – includes RT schools

MS has Volunteer Health Care Practitioners Registry (OK similar law)

IA Consumer protection bill against fraudulent actions by health professionals – including RTs

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Ohio Bills and Regulations HR 127 – amends disciplinary

criteria in the RC Act – must have committed an RT-related offense

Regulations – new rules relating to personal information systems; renewal of license or permits, general respiratory care requirements and reporting mechanisms

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Stay on Top of Changes Bookmark: RC Licensure Board

Bookmark: Ohio Society for Respiratory Care

www.respiratorycare.ohio.gov

www.osrc.org

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Challenges from Other Disciplinesor Professions

Leg or Regs can negatively impact the RT profession, intentional or not

Diminishes RTs scope of practice Additional Education and/or Additional Tests or Credentials you pay

for All to continue services legally

permitted to do under scope of practice

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Other Disciplines (cont.)

Perfusionists: Licensure bills: MN, FL bill explicitly exempts RTs, some RTs do ECMO

Paramedics & EMTs - IN, ID, MT

AND

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State Polysomnograhy Bills/Laws – Impacting RTs

Oklahoma Georgia North Carolina Kentucky Virginia Minnesota Hawaii Maryland California Tennessee

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Polysomnography AAST Model Practice Act is

detrimental to RT profession Requires RTs to be credentialed by

the BRPT or other nationally recognized body for services already in scope of practice

Calls for disciplinary action if RTs don’t adhere to standards

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AAST Model Practice Act Recommended in states as legislative

wording “A respiratory therapist licensed under

Section___ may provide sleep-related services under the general supervision of a licensed physician if the licensed respiratory therapist is credentialed by the Board of Registered Polysomnographic Technologists or other nationally recognized body.”

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AAST Model Practice Act (cont.)

“Respiratory therapists performing sleep-related services shall be subject to disciplinary action by the Board of Respiratory Care if they fail to adhere to the standards established under this chapter.”

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Polysomnography in TN Licensure law follows AAST model

practice act (perhaps other way around)

TN State Society actually supported additional testing of RTs

AARC had to hire TN lobbyist to fight sleep industry and our own society leadership

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Polysomnography in TN (cont.) Legislative compromise was finally

reached –much time and $$ RTs engaged in sleep can either:

Take RPSGT exam Take NBRC’s SDS exam Document competency through

standardized check-off created by TN RC Licensure Board

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The Way it Should Be Iowa Board of RC, Medicare &

Nursing has it right Personnel who have specific

training and competency testing in sleep are qualified

Includes RTs, nurses, RGPSTs, other licensed health care professionals

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AARC Does Not Oppose Polysom Licensure Majority of polysomnography

services include RT services RTs must be permitted to continue

to provide sleep disorder services without additional requirements

No justification to change or single out RT profession

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We Need to Work Together Polysom state legislation will continue

to be a major focus for AARC, state societies and state licensure boards

Clearly other changes on the state level impacting the provision of RT will result in the need for continuing joint efforts between RT Societies and the RT Licensure Boards/Councils/Committees

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Conclusion We have responsibility to continue

to monitor, analyze and respond to good/not so good legislation and regulations/rules

State Society first line of defense, but all RTs must step up and respond if needed

If RTs won’t do it, no one else will…..

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Thank You