Legislative Preview 2007 In 2007, ASHA will continue to press the U.S. Congress on issues important to members: opposing the Medicare therapy caps, securing supplier status for speech-language pathologists under Medicare, urging direct access to audiology services, advocating for the concerns of school-based clinicians affected by the Individuals with Disabilities Education Act and ... Policy Analysis
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Policy Analysis  |   February 01, 2007
Legislative Preview 2007
Author Notes
  • Elizabeth Mundinger, is ASHA’s director of federal and political advocacy. Contact her at 800-498-2071, ext. 4473, or emundinger@asha.org.
    Elizabeth Mundinger, is ASHA’s director of federal and political advocacy. Contact her at 800-498-2071, ext. 4473, or emundinger@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   February 01, 2007
Legislative Preview 2007
The ASHA Leader, February 2007, Vol. 12, 1-15. doi:10.1044/leader.PA.12022007.1
The ASHA Leader, February 2007, Vol. 12, 1-15. doi:10.1044/leader.PA.12022007.1
In 2007, ASHA will continue to press the U.S. Congress on issues important to members: opposing the Medicare therapy caps, securing supplier status for speech-language pathologists under Medicare, urging direct access to audiology services, advocating for the concerns of school-based clinicians affected by the Individuals with Disabilities Education Act and No Child Left Behind, lobbying for a tax credit for hearing aids, and more.
Bipartisanship will be key to the enactment of new legislation this year as Democrats take control of the House and razor-thin control in the Senate, while Republican President George W. Bush holds on to veto power for another two years. In addition, passing bills with large price tags will be difficult. The new House leadership already has passed a “pay-as-you-go” rule, requiring provisions in legislation that will offset any costs.
With the pressure on for the president to establish his legacy and the Democrats to achieve legislative goals, the political debate is likely to be lively. President Bush will need to cooperate with the Democratic leadership in Congress to advance his agenda. Similarly, members of Congress must work with the president to demonstrate that they can pass important legislation and deserve re-election in two years.
Aligning Medicare Policy Objectives
This next year presents unique opportunities for ASHA to encourage Congress to align a number of policy objectives that could improve Medicare benefits for seniors. ASHA will continue to push to repeal or find alternatives to therapy caps; halt steep reductions in the fee schedule; promote speech-language pathology supplier status; and allow direct access to audiologists.
Last year, ASHA successfully urged Congress to extend the therapy cap exceptions process for 2007 and to prevent the scheduled 5% cut in the 2007 fee schedule (see “Medicare Meltdown Averted,” The ASHA Leader, Dec. 26, 2006). In addition, Congress required the Centers for Medicare and Medicaid Services (CMS) to begin gathering quality data for some rehabilitation and physician services. However, much more work needs to be done.
Extension of the therapy caps exceptions process may be viewed as a sign of strong congressional support for repealing the caps. Last year, 260 representatives and 45 senators co-sponsored repeal legislation. However, repeal is unlikely until an alternative process is developed that discourages coverage for services that are not medically necessary. ASHA has urged CMS to align its policy priorities regarding reporting of quality measures and developing a quality-based alternative to the therapy caps. ASHA will work with CMS and Congress to ensure that appropriate quality data for speech-language pathology services are collected as efficiently and conveniently as possible.
ASHA has achieved some success in urging CMS to align its policy objectives in the therapy cap arena. For example, in implementing the therapy cap exception process for 2007, CMS has recommended SLPs use ASHA’s National Outcomes Measurement System (NOMS) as an assessment tool to document a patient’s functional improvement and justify services beyond the caps. Simultaneously, ASHA has been urging Congress and CMS to allow SLPs to use NOMS when reporting quality measures, pursuant to the Medicare provisions passed late last year. CMS could use the data from both of these activities to develop a quality-based alternative to the therapy caps, a request that Congress has made previously.
Although Congress prevented the proposed 5% cut to the 2007 Medicare fee schedule, a proposed 10% cut now is looming for 2008. It will be difficult to offset this cut, which is expected to save the federal government billions of dollars.
On a more positive note, CMS will be implementing a bonus system for providers who voluntarily report quality data. SLPs specifically were named as eligible to report data beginning no later than 2008. Without supplier status, however, SLPs may not directly benefit from any bonus paid. Audiologists were not included in the list of specialties eligible to report quality data voluntarily, largely due to a lack of established process or outcomes quality measures. ASHA will work with Congress and CMS to ensure that ASHA members directly benefit from any bonus program.
ASHA will continue its intensive campaign for SLP supplier status. Last year more than 65 representatives and senators co-sponsored legislation that would allow SLPs in private practice to enroll as suppliers under the Medicare outpatient program. As part of the negotiations on the Medicare legislation, ASHA moved one step closer toward this legislative priority as the Senate version of this bill contained the SLP-supplier language. However, in negotiations with the House, the language was dropped because of concerns about the possible cost to Medicare. Sens. John Ensign (R-NV) and Mary Landrieu (D-LA) have already reintroduced the supplier status bill, S. 45, in the new Congress.
Last year, 60 members of Congress also co-sponsored legislation providing Medicare beneficiaries the option of going directly to a qualified audiologist—rather than requiring physician referral—for hearing and balance diagnostic tests. ASHA will urge reintroduction and passage of this important legislation, which faces stiff opposition from physicians.
IDEA and NCLB
ASHA will continue to fight for increased federal funding for the services its members provide. Although fiscal year 2007 began last October, the FY 2007 funding level for the Individuals with Disabilities Education Act (IDEA) has yet to be finalized. A nominal increase over last year’s level is expected for 2007. Considering the ballooning budget deficit, ASHA must fight hard to ensure there are no cuts in 2008.
ASHA also is preparing for re-authorization of the No Child Left Behind Act, which expires Sept. 30. ASHA has identified some key areas of the law that directly affect school-based members, including a strengthened role for “pupil services providers,” greater access to professional development funds, and a voice in the U.S. Department of Education.
Student Loan Forgiveness
ASHA also will urge adoption of provisions that limit the cost of becoming an SLP or audiologist. In the first 100 hours of Congress, the House Democratic leadership pledged to pass legislation cutting interest rates by half on federally subsidized student loans over five years. It is unclear whether the Senate will consider similar legislation or if President Bush will sign such a bill into law.
The issue of student loan forgiveness likely will return when Congress re-authorizes the Higher Education Act (HEA), set to expire June 30. Last year, the House passed a version of HEA that expanded eligibility for an existing student loan forgiveness program to ASHA members. But the 109th Congress adjourned before finishing its work on this legislation. ASHA will urge adoption of these provisions during this Congress.
Expanding Health Insurance Coverage
ASHA will work with the federal government to urge insurance companies to offer more comprehensive coverage of speech-language pathology and audiology services, perhaps in the form of legislation providing more coverage options for hearing and speech-language services to federal employees.
Tax Credit for Hearing Aids
ASHA will continue urging Congress to adopt a tax credit for some hearing aids. Last year, 111 representatives and 18 senators supported hearing aid tax credit legislation. This bill is costly and thus may run into significant opposition from the House “pay-as-you-go” rule.
There are many ways for ASHA members to participate in lobbying efforts. The “Take Action” Web site (http://takeaction.asha.org) is regularly updated with information about pending legislation and other issues. ASHA is planning several write-in and call-in campaigns; to receive updates about these campaigns, please add our e-mail address, grassroots@asha.org, to your contact list (so that ASHA e-mails are not deemed spam).
Finally, members willing to become more active on a local level by attending local events and speaking to other SLPs and audiologists about legislative priorities may contact Deborah Darcy, ASHA’s director of grassroots advocacy, at 800-498-2071, ext. 4427, or ddarcy@asha.org.
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February 2007
Volume 12, Issue 2