indiana dietetic association legislative update martha rardin, msm, rd, cd indiana public policy...
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Indiana Dietetic AssociationLegislative Update
Martha Rardin, MSM, RD, CDIndiana Public Policy Coordinator
Future of Healthcare Professions is determined by the Congress of the US, not Associations, your education, or your professional career.
Who Pays For Healthcare?
From:Private Ins-35%Medicare-17%Medicaid-16%Out-of-pocket-14%Other Public-12%
To:Hospitals-31%Docs-22%Drugs-11%NH-7%Other-22%Adm-7%
Medicare
Federal Health Insurance Program (1965)CMS Administers65, <65 and legally blind, or disabled, End
State Renal Disease (ESRD)Part A (Hospital and Nursing Home)Part B (Outpatient)Part C (Insurance companies contract with
Medicare for HMO and PPO coverage)Part D (Drug Prescription Coverage)
Medicaid
Joint Fed and State Program
Medical costs for low/limited income
Vary from state to state
Who Pays For Healthcare?
Medicare 50% goes to Hospitals and Skilled Nursing
Facilities Funds 17% of Long Term Care (nursing homes) Federally funded
Medicaid State funded Funds 47% of Long Term Care
IS Universal Health Care the Answer?
Will Universal Health Care solve our healthcare woes?
Is a Public Option viable?
Who pays for access? Will taxpayers be taxed
more? Will users of healthcare
pay any premiums? Watch the healthcare
debate carefully!
Influencing Policy
Lobbying = Marketing
Need Access to politiciansAll Politics Is Local
Provide Local Influence Provide Local Insight Provide Local Experiences
Communicating Effectively Who, Why, What, Where, When Attend Town Hall meetings or visit your elected officials
Long Term Relationship (give and take)Making friends outside of your circle and
interest
Two Kinds Of People
Those who choose to be players
Those who choose to be victims
Two Kinds Of People
Those who choose to be players
They vote. Communicate with
lawmakers on issues that directly concern them.
They communicate with email or by meeting with officials when they are on recess.
Help elect candidates who best represent them.
Those who choose to be victims
They do not vote (or only vote).
They live with the political decisions that others are able to influence.
They don’t understand the political process and just want someone to “fix it”.
Influence Policy
Persuasion Have the Knowledge
Political Power More Impt than Facts How to get it? You have to be a player
Political Power
36% don’t vote
23% not registered
24% underage
17% decide!
Political Power YOU have Power!
Individual Contribution (up to $2,300) to each candidate per election
Political Action CommitteesPACS may give up to$2,300/election/candidate
National parties may contribute up to $5,000/election
Politicians are always running for office and always raising money – donate regularly
Who Is My Legislator?
www.accessIndiana.govType in elected officeType in zip code
From Idea to Law by the “Book”
Senate House Conference Committee
Subcommittee Full Committee Senate
Full Committee Senate House Full Committee
Member of Congress House Full Committee Subcommittee
President
Public Law Veto
Senate House
How to get a bill passed
Constituent input to “right” Rep. or SenatorFacts to support debateUnderstand Congressional timetablesUnderstand Congressional committee
assignmentsBuild support over period of time, most bills
do not pass first time they are introducedBills introduced in one Congress are not
extended to the next, but must be reintroduced—all bills die when Congress adjourns.
How to communicate with your congressman or legislator
Email is best Legislators don’t get a lot
of mail from constituents May or may not receive a
response Make your message
concise, polite, and ASK for their support for or against your issue
Provide facts but not stacks of facts
Provide data on how this affects his/her constituents
What can you do?
VOTE Vote in every primary,
school board election, general election
Volunteer for your candidate
Donate money to a candidate
Place a sign in your yard or window
Read the paper and follow current events daily
American Dietetic Association
What have you done for me lately?
ORWhat have YOU done lately for ADA?
ADA’s #1 GoalBe included in Health Care Reform Legislation!Physicians know nutrition therapy can improve
health outcomesLack of physician reimbursement is the reason
80% of physicians cite for not addressing nutrition services
Chronic disease accounts for 75% of the $2 Trillion spent annually on healthcare
Nutrition has been shown to be highly cost-effective in preventing and managing chronic disease – but nutrition services is usually not a routine covered benefit. ADA Times, Summer 2009, Volume 6, Issue 4
ADA’s Public Policy Goals
Food and Nutrition Is Key To HealthAdvocate for Public Health and
ProfessionSafe and Nutritionally Adequate Diet
For All.Based on ScienceDisease Prevention and TreatmentEvidence-based MNT
ADA’s Public Policy Priorities
AgingChild NutritionMNT (Medicare and Medicaid)Nutrition MonitoringNutrition Research Obesity and Weight ManagementState Issues
ADA’s Public Policy Update
Aging (Older Americans Act-entitlement program)
Child Nutrition (WIC-entitlement program)Medical Nutrition Therapy (want this
expanded beyond diabetes coverage)Nutrition Monitoring (want this expanded
and funded)Nutrition Research (want this expanded)Obesity and Weight Management-monitorState Issues-monitor
Some Issues we watch at PPW
Medicaid Medicare MNT Act of 2005Ryan White Care ActOlder Americans ActDietary GuidelinesObesityFarm BillState statutes on certification and licensure
2005 Dietary Guidelines
Federal Nutrition Policy/ProgramsHHS/USDA Legislative Every 5 YearsScience-basedCurrently under revision but needs
increased fundingPromote healthy, prevent chronic
disease
So what’s the problem with reimbursement?
Unfortunately long term studies involving the success of prevention are in short supply.
The Congressional Budget Office (CBO) only recommends coverage for procedures/interventions that can PROVE cost savings.
The CBO uses a 10-year period to determine cost effectiveness.
As RD’s we know 10 years may not be enough time to illustrate the savings in the long-term due to the prevention of complications.
A lack of research is contributing to our lack of reimbursement.
So what’s the problem with reimbursement?
Diabetes prevention and treatment programs that incorporate screening, education and nutrition counseling are effective but many times the effectiveness of complication prevention may exceed the 10 year window.
Rep. Donna Christensen (D-VI) has introduced legislation that would allow the CBO to score preventative health services using a 25-year window.
ADA has signed on to support this initiative. Source: ADA’s On The Pulse, 9/4/09
ObesityIRS
Allowable Medical Expense Deductions: In total medical deductions amt pd for
weight loss IF Tx for disease diagnosed by MD (obesity, HTN, CVD)
Bariatric Surgery, MNT, Approved Drugs Fees at gym for separate activities Special foods only beyond normal needs
ObesityCMS
Has NOT designated obesity as disease“Treatments for obesity alone remain non-
covered and coverage for treatments resulting in or exacerbated by obesity remain unchanged.”
“Services in connection with the treatment of obesity are covered when services are an integral part of a course of treatment for a medical condition such as hypothyroidism”.
Current and Past Issues
Indiana School Food Quality BillPhysician’s Reimbursement?Certification Status
Licensure or Certification?
Licensure defines scope of practice - defines what you can and cannot do as a dietitian
Certification defines the profession - the educational requirements for someone to call themselves a dietitian
Certification does not define scope of practice
Licensure is preferable but difficult to enact.
Indiana has Dietitian Certification
Dietitian Certification Application Formhttp://www.in.gov/icpr/webfile/formsdiv/47
586.pdf
Dietitian Certification-Title 830http://www.in.gov/legislative/iac/iac_title?&
iacv=iac2003&iact=830&iaca=all
Displaying Dietitian Certification Certificatehttp://www.in.gov/legislative/ic/code/
title25/ar14.5/ch4.html
The Pitch!
Legislative InvolvementIt is up to you and I!
Public Policy WorkshopDay at the State HouseYOU are the dietetic
professional – YOU have tospeak up for your interests!
Resources
On The Pulsewww.eatright.orgwww.dietetics.com/idaADA’s Medicare MNT Provider
Newsletter
