Legislative Preview 2006 Key Issues Left Unresolved Policy Analysis
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Policy Analysis  |   February 01, 2006
Legislative Preview 2006
Author Notes
  • Reed Franklin, is ASHA’s director of federal and political advocacy. Contact him at rfranklin@asha.org.
    Reed Franklin, is ASHA’s director of federal and political advocacy. Contact him at rfranklin@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   February 01, 2006
Legislative Preview 2006
The ASHA Leader, February 2006, Vol. 11, 1-19. doi:10.1044/leader.PA.11022006.1
The ASHA Leader, February 2006, Vol. 11, 1-19. doi:10.1044/leader.PA.11022006.1
Legislative activity will pick up in 2006 at nearly the same spot it ended in 2005. Congress ended the year in a late session after trying–and failing–to tie up a number of politically tricky items.
Several issues of importance to ASHA members—including Medicare, education, and direct access to speech-language pathology and audiology services—were left unresolved. Most media attention at the end of the 2005 session focused on high-profile issues such as drilling for oil in the Alaskan wilderness and the USA Patriot Act.
Upon its return in early February, Congress will face the same political climate that produced gridlock last year. Although the Republican leadership is determined to move its agenda, Democrats seem emboldened by President Bush’s low poll numbers and a series of scandals that are rocking congressional Republicans. Many observers believe that bipartisan cooperation is at an all-time low.
The federal budget deficit also continues to mount, making it extremely difficult to find funding for programs that are not related to defense or homeland security.
Despite these challenges, ASHA has an ambitious legislative agenda for 2006 that addresses critical needs of ASHA members and the patients, clients, and students they serve. ASHA will continue to be very active on Capitol Hill, and all ASHA members are encouraged to be active grassroots advocates as well.
The following articles highlight some specific issues on which ASHA is working in 2006.
Medicare
At the end of 2005, Congress was in the process of working on legislation that made significant changes to Medicare. The Deficit Reduction Act (DRA) of 2005, also referred to as the budget reconciliation bill, would have made changes in the Medicare outpatient therapy cap, the physician fee schedule, and the 75% rule, among other items.
Although the bill passed both the House and the Senate in 2005, there were minor differences in the bill’s content as it passed the two chambers. The legislation must pass both the House and the Senate in identical form before it can go to the president for his signature, so the House is expected to take the bill up early this year.
Under the bill, the Medicare outpatient therapy caps would be implemented in 2006 with an exemptions process allowing Medicare patients to receive medically necessary services beyond the financial limitation of $1,740 per year. 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 $1,740, 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 exemptions process would be implemented. However, CMS would be allowed to implement procedures for exceeding the cap through instructions to its contractors, rather than using a formal rulemaking process. ASHA will provide further information to members on this exemptions process as CMS guidance becomes available.
If enacted, the DRA would avoid a 4.4% cut in the annual update to the 2006 Medicare fee schedule. Most speech-language pathology procedures would receive the same payment in 2006 as they had in 2005.
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 “75% Rule”
The DRA would also extend the phase-in of the so-called “75% rule” for inpatient rehabilitation facilities (IRFs) over three 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 (up from the current 50%) do not fall within one of 13 diagnoses/conditions. Beginning on July 1, the determination rate would be set at 60%, move to 65% in July 2007 and 75% in July 2008.
Passage of the DRA would be the start of ASHA’s efforts on the Medicare outpatient therapy caps. The provision on the caps in the DRA, however, only apply to 2006, so clearly Congress envisions a more permanent change by the end of the year. ASHA will continue advocacy activities on the caps in an attempt at convincing Congress to address the caps once and for all.
Direct Access
Another top ASHA priority in Medicare is passage of H.R. 3795 and S. 657. This legislation would make a technical correction to the Medicare Part B outpatient statute by separating the speech-language pathology and physical therapy provisions. This change would permit SLPs to be recognized as suppliers of service and allow them to bill Medicare directly from private practice.
Although Medicare does allows for reimbursement of all medically-necessary speech-language pathology services, the CMS interpretation of the speech-language pathology outpatient section of the statute runs contrary to policies established by other government health care programs (such as those administered by the Veterans Health Administration and Medicaid) and private health plans, which allow SLPs to directly bill for their services.
H.R. 3795 and S. 657 would revise the outpatient statute to conform with other parts of the Medicare program that clearly recognize speech-language pathology as a distinct and separate profession from physical therapy.
Significant progress was made in 2005 and ASHA will continue working on this important issue.
Education: IDEA, HEA, and NCLB
ASHA is monitoring implementation of the Individuals with Disabilities Education Improvement Act (P.L.108-446) enacted on Dec. 3, 2004. Many of the provisions of this revised IDEA law went into effect on July 1, 2005. At press time, final regulations on the new law have not been issued as promised and are now not expected until this spring or summer.
One item left over from 2005 is the Higher Education Act (HEA), which was expected to be reauthorized last year with the House Education and the Workforce Committee reporting H.R. 609 to the full House of Representatives for consideration on Sept. 22, 2005. Nonetheless, the House did not take action on the bill last year.
The Senate, similarly, is in the same position as the House regarding the reauthorization of the HEA. On Nov. 17, 2005, the Senate Health, Education, Labor, and Pensions Committee reported out an HEA bill, S. 1614, to the full Senate for consideration without any further action occurring on the bill. Some student loan provisions, which account for the majority of funding in the HEA, were included in a year-end budget-cutting bill. However, a majority of the provisions and programs authorized under the HEA (including student loan forgiveness) are still under consideration by both chambers. ASHA members can expect a resolution on the HEA early this year.
Finally, the countdown to the reauthorization of the No Child Left Behind Act (NCLB) has begun with less than two years before the law expires on Sept. 30, 2007. ASHA has started preliminary work on reauthorization of NCLB. ASHA members should look for an increase in “chatter” on the law as teachers’ unions, administrators, school boards, and others stake out positions on key issues such as testing, teacher quality, funding, and student progress. ASHA members can also expect the congressional committees with jurisdiction over NCLB to hold hearings to examine various aspects of the law.
Direct Access to Audiology Services
The Hearing Health Accessibility Act, H.R. 415 and S. 277, is bipartisan legislation that would allow Medicare beneficiaries the option of going directly to a qualified audiologist for hearing and balance diagnostic tests. Currently, Medicare beneficiaries with hearing loss or balance disorders are required to obtain a physician referral before seeing an audiologist.
Significant progress was made last year. H.R. 415 has more than 10% of the members of the House of Representatives as co-sponsors despite significant opposition from the physician community.
Efforts to change physician oversight rules in Medicare are always long and drawn-out battles. ASHA will continue its advocacy and it is vital that ASHA members continue to advocate on this important issue.
Grassroots Advocacy
With ASHA’s ambitious agenda and the challenging climate on Capitol Hill, it is vital that all ASHA members work together to achieve our goals. There are several ways you can help.
First, your individual advocacy is tremendously important. Your elected officials are accountable to you, so let your voice be heard. You can go to our Take Action Center to learn the simple steps in becoming an effective advocate.
Second, the ASHA Political Action Committee is a vital tool for supporting the elected officials who support our issues. Even a small contribution makes a big difference. You can go to Learn About ASHA’s PAC for more information about how you can donate.
Finally, talk to your colleagues about the importance of getting involved in legislative issues.If everyone helps, we can achieve our goals-even in this challenging year.
2006 Public Policy Agenda

Each year, ASHA develops a public policy agenda with input from members to help determine the Association’s priorities for the year. Below are ASHA’s highest priorities for 2006:

  • Promote direct patient access to audiology and speech-language pathology services for Medicare beneficiaries, including direct billing and ensuring that both the work component and the technical component for services are included in the fee schedule.

  • Promote full funding and implementation of the Individuals with Disabilities Education Act (IDEA), with emphasis on the recruitment and retention of highly qualified personnel, reducing caseloads/workloads, and providing services to culturally and linguistically diverse children.

  • Promote federal financial aid policies and priorities that support recruitment of students to doctoral programs and retention of PhD faculty and researchers, with emphasis on culturally/linguistically diverse candidates.

Visit ASHA’s 2006 Public Policy Agenda to learn more.

Support ASHA-PAC

ASHA-PAC’s annual fundraising campaign is underway. ASHA-PAC is the political action committee advocating on behalf of the professions. Your financial support makes it possible to keep up the fight to repeal the herapy cap, demand direct access to audiology services, and more.

Phone calls will be made by an outside contractor, Membership Marketing Service (MMS) of Virginia Beach, VA. MMS is excluded from the National Do Not Call Registry under the established business relationship provision. However, MMS will honor Do-Not-Call and remove any ASHA member on the list. ASHA members currently not on the list also can request to have their names removed. For information, contact Stefanie Reeves at sreeves@asha.org or Reed Franklin at rfranklin@asha.org.

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FROM THIS ISSUE
February 2006
Volume 11, Issue 2