American Association for Respiratory Care PACT MEETING

1. American Association for Respiratory CarePACT MEETING Marriott DFW Airport North Sunday, March 30, 2008 Miriam O’Day (oday@aarc.org) Legislative Affairs

2. 2008 is an Election Year One third of the Senate is up for election The entire House of representatives is up for election Members of Congress will be tuned in to the voters - now is the opportunity to hold them accountable

3. AARC 2008 Legislative Agenda Medicare Respiratory Therapy Initiative HR 3968 S 2704 Pulmonary and Cardiac Rehabilitation S 329 HR 552 CDC COPD Program and Action Plan Appropriations Request with Professional Judgment

4. How things get done in Washington Committees Committees of jurisdiction over Medicare issues House Ways and Means House Energy and Commerce Senate Finance Committee State Delegations View them as a whole PACT - Making the Personal Connection Consistency - Relationships

5. How things get done in Washington Committees Committees of jurisdiction over Medicare issues House Ways and Means House Energy and Commerce Senate Finance Committee State Delegations View them as a whole

6. Congressional COPD Caucus Fighting the 4th Leading Cause of Death Important Legislative Agenda Includes Airline Oxygen Reimbursement for Pulmonary Rehab Increasing Data Collection COPD CDC Chronic Disease Program Language Colloquy

7. Pulmonary and Cardiac Rehabilitation • HR 552 and S 329 • CMS - No National Coverage Determination - “Lacks Legislative Authority” • After PACT 12 Additional Co-Sponsors for the House - 179 • After PACT 1 new Senate Co-Sponsor - 41 • Medicare Provisions Expire June 30 • From Senate to House • Hired Democratic “Closer” • Elmendorf Strategies - AARC; AACVPR; NAMDARC; ATS; COPD Foundation

8. What will happen with Medicare? • Will Pulmonary Rehab be included? • How will it be paid for? • How large will the package be? • In play… • Competitive Bidding released last Thursday • Oxygen down from $200 @ ~ 150 • Oxygen Cap Reduction from 36 -18 or 13 • 18 months? • The larger the package the greater the chances of other provisions included

12. Oxygen Reimbursement (Cap) DRA reduced coverage Ceded ownership to Medicare Beneficiary after 36 Months (January 2006) Modality Specific Reimbursement Administration Budget Recommends Reduction to 18 months Congressional Discussions about 13 months (Farm Bill)

13. Oxygen Reimbursement (Cap) • US COPD Coalition • Letter to Senate Finance Committee • “First Do No Harm” • Recommends • Reviewing Patient Safety Data • Access to Appropriate Equipment • GAO Study

14. Stimulate Public Health Infrastructure CDC COPD Program Appropriations Language Amendment Professional Judgment Coalition - ALA; ATS; COPD Foundation Alpha-1 CDC Language Development of COPD Program Must Consider Genetic Component

15. Medicare Respiratory Therapy Initiative Partnership - Healthcare Professionals Extending Benefits Access to Respiratory Therapists for Medicare Beneficiaries Under Part B HR 3968 Senate Companion S 2704

16. Medicare Respiratory Therapy Initiative Legislators must be educated about the profession and the impact of pulmonary disease on individuals Legislators cannot support legislation unless they know it exists Legislators need to know about constituent support Always make it personal

17. Medicare Respiratory Therapy Initiative House Bill HR 3968 Primary Sponsor - Mike Ross (D-AR) Senate Bill S 2704 Primary Sponsors Blanche Lincoln (D-AR) Mike Crapo (R-ID)

18. Medicare Respiratory Therapy Initiative Amends Medicare law to permit RRTs with a bachelor degree to work under general physician supervision These RTs could provide their scope of practice without the physician having to be on site under Medicare Part B

19. Medicare Respiratory Therapy Initiative If enacted qualified RRT with a bachelors degree will be able to expand their opportunities to provide services for the Medicare patient outside of the institutional setting Bachelors degree does not have to be in respiratory therapy

20. Medicare Respiratory Therapy Initiative Impact Physician offices: Patients have greater access to respiratory therapists Physician does not have to be present Smoking cessation Disease Management Asthma Management Diabetes Inhaled Insulin MDI/DPI device selection and patient medication education

21. Medicare Respiratory Therapy Initiative The Future of Respiratory Therapy: Current law does not permit independent practice or billing This initiative does not permit independent practice or billing 85% of Physician Fee Schedule Details of Implementation will be negotiated with CMS in a regulatory process

22. Medicare Respiratory Therapy Initiative The Future of Respiratory Therapy: Allows data collection to evaluate outcomes and substantiate the value of respiratory therapists in the entire array of non-hospital sites This type of outcome data will enhance the entire profession of respiratory therapy and all respiratory therapists

24. Medicare Respiratory Therapy Initiative White Paper Scope of Practice and State Licensure Cost Estimate Reliable Outside Source FAQ One Page for Congressional Staff Allied Health Chart Statute and Credentials Dear Colleague Letters

25. Medicare Respiratory Therapy Initiative 435 Plan This is an RT Bill - Congress expects to hear from RT’s What is good for the profession is good for patients Use this tool to develop the patient community - they need you - we need them - Create a TEAM

26. Medicare Respiratory Therapy Initiative White Paper Scope of Practice and State Licensure Amendments to Medicare Statute always raise questions about “turf” Will RT’s be expanding their scope of practice? Who’s territory are we stepping into? White paper addresses these questions

27. Medicare Respiratory Therapy Initiative Cost Estimate Congressional Budget Office (CBO) evaluates federal governments cost for all legislation that is under serious consideration Many organizations obtain an “outside” score to estimate this cost

28. Medicare Respiratory Therapy Initiative • Cost Estimate • United BioSource Corporation • Don Muse and Associates • $5 million over 5 years • Cost is low due to “self-limiting” benefit - credentials • Sources of Data • Price and Utilization Assumptions CMS 2005 Physician/Supplier Procedure Summary Master File • Demographic Data from the AARC 2005 National Manpower Survey

29. Medicare Respiratory Therapy Initiative • FAQ • One Page for Congressional Staff • Addresses • Law • Credentialing • Initiative • Substantiates Need

30. Medicare Respiratory Therapy Initiative • Allied Health Chart • Statute and Credentials • Sites all areas of statute that recognizes non-physician providers • Sites all credentials • States that allied health professionals require advanced credentials in Part B

31. Medicare Respiratory Therapy Initiative • Dear Colleague Letter • From Members of Congress to their Colleagues • “Official” endorsement of RT’s and the Initiative • Both House and Senate Letters are “FRESH” - March 2008

32. Medicare Respiratory Therapy Initiative Supporting Organizations American Thoracic Society (ATS) American College of Chest Physicians (ACCP) AARC Board of Medical Advisors (BOMA) BOMA is comprised of representative organizations No Known Opposition

33. Medicare Respiratory Therapy Initiative Following PACT Meeting 130/275 meetings indicated support

34. Medicare Respiratory Therapy Initiative COPD - is being branded Fourth Leading Cause of Death Only One in Top Five on the Rise 12 million diagnosed 12 million undiagnosed One Death Every 4 minutes Leading Cause of Disability State COPD Action Plans National Celebrity Spokesperson

36. Medicare Respiratory Therapy Initiative COPD Recasts Emphysema and Tobacco to focus on Chronic Disease Move from Shame - Blame to prevention, treatment and management NIH - NHLBI National Education and Awareness Campaign “Learn More Breathe Better” CDC Program in Chronic Disease Center

38. Medicare Respiratory Therapy Initiative CDC Program in Chronic Disease Center PACT Appropriations Request Garnered Support Udall (D-NM) Member Subcommittee Placed Request at $6 Million Larry Garland Bob Quintella 165/375 Members Indicated Support Organizational Sign-On Letter Dear Colleague

39. Medicare Respiratory Therapy Initiative Don’t Forget the Follow-Up: Extend an Invitation Schedule a District Meeting Generate Patient Support Letters to the Editor - Generate local press coverage

40. Medicare Respiratory Therapy Initiative Let’s share information Tell us about your success Tell us about your ideas

41. Thank You Sherry Milligan Cheryl West Anne Marie Hummel Respiratory Therapists

42. DISCUSSION QUESTIONS RECOMMENDATIONS