CMS Marketplace Fact Sheet
The "Expanded Coverage Under the Affordable Care Act: Information for Health Care Professionals" Fact Sheet (ICN 908826) is now available in downloadable format. This fact sheet is designed to provide education on the Health Insurance Marketplace under the Affordable Care Act. It includes information health care professionals need to know about the Marketplace, an explanation of how the Affordable Care Act expands access to health coverage, and an explanation of the Marketplace, how it affects health care professionals and their patients, and resources. To view Fact Sheet, please click the link below:
NYSED Letter of Clarification for Music Therapy as a Related Service
Important News for New York Music Therapists!
Thanks to advocacy by AMTA member Elizabeth Schwartz, New York music therapists now have an official "clarification letter" from the New York State Education Department regarding the recognition of music therapy as a related service under the Individuals with Disabilities Education Act (IDEA), the federal special education law.
This letter will be instrumental in supporting the provision of quality music therapy services in school districts throughout the state for any child found to be in need of music therapy.
The original purpose of IDEA was to establish a statutory right of all children to a free, appropriate public education specifying special education and related services as the vehicles to provide support for the inclusion of students with disabilities in regular education classrooms. Related services are defined in the bill under Part B as those services deemed necessary to help the child benefit from special education. Appropriate related services are to be specified in the Individualized Education Program (IEP). Published regulations provide that the law’s list of related services is not exhaustive and may include other developmental, corrective, or supportive services if they are required to assist a child with a disability to benefit from his/her special education. A school district is required to supply those services that will enable a child to receive a free and appropriate special education (FAPE).
Even though qualified music therapists have been providing music therapy as a related service to literally thousands of children with disabilities in every state of the nation over the course of the thirty-seven plus years since the passage of Public Law 94-142, the New York State Education Department had never provided specific clarification regarding the use of music therapy in special education.
Earlier this year, a Long Island pre-school program discontinued music therapy services, indicating the cuts were in part due to the fact that music therapy was not a state-approved related service. In an effort to address this problem, Elizabeth Schwartz prepared support materials about the profession, including a reference to information AMTA had obtained from the U.S. Department of Education (http://www2.ed.gov/policy/speced/guid/idea/iep-qa-2010.pdf) and presented these documents to state officials. Although Elizabeth had previously received an email indicating that New York recognized music therapy as a related service, she requested written clarification of this recognition from the Department to assist in educating local district administrators and program staff.
On August 8, 2013, the Office of P-12 Education: Office of Special Education, Coordinator of Special Education Policy and Professional Development provided the attached letter in response to Elizabeth’s request. This document provides guidance representing the interpretation of the New York State Education Department and clarifies the recognition of music therapy as a related service under IDEA. It is recommended that all New York music therapists maintain a copy of this important document within their professional files to utilize in educating administrators and consumers about the state’s recognition of music therapy within special education. Further, music therapists outside of New York are encouraged to use this letter as a template for advocacy efforts in their own states.
Elizabeth will be facilitating a round-table discussion regarding this process at the April 2014 MAR conference in Buffalo, NY.
Affordable Care Act (ACA): Resources
The Affordable Care Act (ACA) allows each State the opportunity to establish Affordable Insurance Exchanges (Exchanges) to provide individuals and small business employers the opportunity to purchase affordable health insurance coverage. Exchanges will provide competitive and affordable rates for health insurance consumers. Consumers will be able to directly compare qualified health plans (QHP’s) and purchase private health insurance options on the basis of price, quality and many other factors. The creation of Exchanges is essential to reaching the goals of affordable healthcare and insuring all Americans.
Health Insurance Marketplace open enrollment starts October 1, 2013 and ends March 31, 2014. Coverage can begin as soon as January 1, 2014.
Implementation of the Affordable Care Act (ACA) continues to move forward, please find below a few resources that you might find helpful:
· State-by-state fact sheets that show who has been helped and how by the health care law
· The "Health Care Changes Wizard," which walks business owners through the new health insurance options and helps them find health care resources
This account will be used for shopping for plans in the health insurance marketplace and for completing the application for premium tax credits that will help with the costs of health coverage.
Although users will have to wait until October 1 to apply for health coverage, they can use their account now to find out what coverage options they may qualify for and to sign up to receive timely information based on their health care needs and interests. Users can also view a checklist that will help them get ready for open enrollment.
Next Steps in Implementation of the Health Insurance Marketplace
On August 5th, 2013, HHS Secretary Sebelius announced the addition of a new feature to HealthCare.gov, the official Health Insurance Marketplace website, that allows people to create a personal account - including a username and password - which is the first step to enroll in new coverage options in the Marketplace.
HHS also launched a call center specifically to serve small businesses interested in the SHOP Marketplace (https://www.healthcare.gov/small-businesses/
). The Small Business Health Options Program (SHOP) launches on October 1 to give small businesses new ways to provide coverage to their employees.
PROTECT REHABILITATION SERVICES CRITICAL TO MEDICARE BENEFICIARIES WITH INJURIES, ILLNESSES, DISABILITIES AND CHRONIC CONDITION
WRITTEN TESTIMONY ON PROPOSALS TO REFORM MEDICARE POST-ACUTE CARE BEFORE THE HOUSE WAYS AND MEANS HEALTH SUBCOMMITTEE
JUNE 28, 2013
Thousands of individuals with disabilities and chronic conditions utilize Medicare to access the rehabilitation services they need to remain healthy, functional, and live as independently as possible in their homes and communities. According to the Centers for Medicare and Medicaid Services (CMS), more than two thirds of Medicare beneficiaries, or about 21.4 million individuals, had at least two chronic conditions in 2010. To these individuals and others with injuries and illnesses, Medicare is a lifeline to a better quality of life through improved health and functional status.
In connection with the June 14 hearing to examine the President’s and other bipartisan Medicare proposals related to post-acute care, the House Ways and Means Health Subcommittee is considering numerous changes to the Medicare program that impact people requiring varying levels of rehabilitative care in inpatient and, potentially, in outpatient settings. We hope the Subcommittee is sensitive to the importance of preserving access to high quality rehabilitation care under the Medicare program. Senator Kirk, Senator Johnson, and former Congresswoman Gabby Giffords offer compelling examples of how comprehensive rehabilitation leads to a return to health, function, and independent living.
As representatives of people with disabilities and chronic conditions and providers who serve them, the undersigned organizations of the Coalition to Preserve Rehabilitation recognize the importance of Medicare reforms that prolong and strengthen the long term viability of the program. However, we have serious concerns with efforts to unduly focus Medicare spending reductions in settings in which post-acute care is provided, particularly in inpatient rehabilitation hospitals and units (IRH/Us) as well as outpatient therapy services.
Overall, Medicare spending growth has been extremely low over the past three years and the Congressional Budget Office has projected this historically low rate of growth as contributing hundreds of billions of dollars in deficit reduction. In addition, Medicare data establish that spending in the IRH/Us setting has remained relatively flat over the past decade due in part to policy changes made by previous Congresses.
As members of the Coalition to Preserve Rehabilitation (CPR), we strongly believe that any changes to the Medicare program should not have the effect of impeding access to rehabilitation and other post-acute care services. Congress should avoid proposals that decrease short-term healthcare expenditures by simply shifting costs to beneficiaries, decreasing benefits, or erecting policy barriers that affect beneficiaries by channeling them into settings of post-acute care that do not meet their individual rehabilitation needs in terms of amount, duration, intensity and scope of rehabilitation services.
A number of pilots and demonstrations authorized under existing Medicare law are already reforming the Medicare post-acute care system and these reforms ought to be given time to achieve their promise. New delivery models that focus on persons with multiple chronic conditions are in their infancy and should be give time to demonstrate their value. Bundling proposals are being pursued that have not yet had the opportunity to produce meaningful results and CMS has not even implemented some existing programmatic requirements to date (i.e., the Continuing Care Hospital pilot program). These and other programs should better align financial incentives with coordination of high quality care and prioritize care provided in the home and community while preventing unnecessary institutionalization, readmissions, and promoting person-centered care and decision making.
Inpatient Rehabilitation Hospital Proposals
With respect to some of the post-acute care proposals currently being considered by the Committee, the Coalition to Preserve Rehabilitation opposes policies that would severely restrict access to IRH/U services for Medicare beneficiaries with injuries, illnesses, disabilities and chronic conditions.
As this Subcommittee considers Medicare proposals that reduce spending to offset the cost of a fix to the physician fee schedule or otherwise reduce the overall deficit, we ask you to NOT include in your legislation the following proposals.
1. Cuts to Future Investments in Inpatient Rehabilitation Hospitals and Units
The magnitude of aggregate reductions in annual inflation updates to IRH/U care included in the President’s most recent budget proposal, is completely disproportional to Medicare expenditures in this setting of care. According to the data, Medicare expenditures for IRH/Us has been relatively flat for the past several years, in stark contrast to many other areas of both acute and post-acute care spending under the program. In fact, Medicare spending on inpatient rehabilitation services makes up only 1.2% of total Medicare spending and only 11.4% of Medicare spending on post-acute care services. During the hearing, Jon Blum was specifically asked about appropriate margins and he stated that anytime margins were in the double digits the Agency felt this was problematic. Given that this double digit threshold has not been exceeded it would be inappropriate to impose market basket reductions. Large spending reductions in post-acute care will deal a serious blow to the capacity of IRH/Us—and all post-acute settings—to accommodate the needs of an aging population with disabling conditions. Inpatient hospital rehabilitation is cost-effective by maximizing the functional capacity of individuals who receive such services. The ability to leave the hospital and live as independently as possible in the home and community-based setting, as opposed to spending long periods of time in institution-based care or being readmitted to the acute care hospital, will avert the need for enormous unnecessary spending for these beneficiaries in future years.
2. Increasing the 60% Rule for Inpatient Rehabilitation Hospitals and Units
We oppose raising the 60% rule, which was established by Congress in 2007, up to a 75% compliance threshold, a percentage that would clearly restrict access to IRH/U services. This is an issue that has been debated for several years and that Congress has resolved. Congress settled this debate in the Medicare, Medicaid and SCHIP Extension Act of 2007 ("MMSEA") with the implementation of a reasonable rule that has been demonstrated to permit appropriate access to inpatient hospital rehabilitation in the years that have followed. The data clearly establishes that the 60% Rule is working in its current form. Inpatient rehabilitation has not experienced nearly the same increases in Medicare expenditures that other settings of post-acute care have over the past several years. Raising the rule from 60% to 75% would simply take clinical decision-making out of the hands of physicians and the rehabilitation team and place those decisions into the hands of bureaucrats. We strongly urge you to preserve the 60% rule so as to not erect arbitrary barriers to intensive, hospital-based rehabilitative care.
3. Site-Neutral Payment Proposals
This proposal would reduce significantly access to inpatient rehabilitation for patients with particular conditions. These conditions, depending on the severity of the patient, are treated in bothIRH/Us as well as Skilled Nursing Facilities (SNFs). The fallacy behind this proposal is that similar patients achieve equal outcomes when treated in either setting. But even the study that the Medicare Payment Advisory Commission (MedPAC) cites for this proposition states that its "results are preliminary, and additional work is needed to define clinically meaningful differences in self-care and mobility functional status." (See, Research Triangle Institute Study, Vol. 4, Sec. 8, page 58.) Implementation of site-neutral payment for patients with hip fractures, joint replacements and other conditions would simply eliminate access to intensive rehabilitation programs by erecting a financial disincentive for admission of these individuals in IRH/Us. This appears to be just another proposal to drive patients to less intensive, less appropriate rehabilitation settings, rather than the setting that best meets their rehabilitation needs.
Outpatient Therapy Services
The Coalition to Preserve Rehabilitation cannot pass up the opportunity in the context of this hearing to express our dismay with CMS’s implementation of the exceptions process medical manual review to the Medicare outpatient therapy caps. Although consumer and disability organizations have long opposed these arbitrary caps in therapy benefits, CMS’s current use of Recovery Audit Contractors (RACs) to review claims in excess of $3700 per person is highly objectionable. The use of RACs to assess whether therapy services for these beneficiaries are reasonable and necessary creates a presumption of fraud, abuse and overutilization, and creates a chilling effect on access to services above this $3700 cap.
This cap serves to deny care to the very individuals who need it most, approximately 5% of those requiring outpatient therapy services. This policy has a disproportionate impact on people with disabilities and chronic conditions who utilize therapy services to improve, maintain and prevent deterioration of their function and health status. We ask the Subcommittee to (1) prevent CMS from utilizing RACs to administer the outpatient therapy benefit, (2) extend the exceptions process for the therapy caps beyond December 2013, (3) streamline the exceptions process for those with documented disabilities and chronic conditions, and (4) consider redesigning the physical therapy, occupational therapy and speech-language pathology benefits to focus on functional outcomes rather than arbitrary caps on the benefit.
The disability and chronic illness community understand the magnitude of the problem that our nation faces in attempting to contain federal spending and finally fix the physician fee schedule. However, achieving significant federal savings on the backs of people with disabilities and some of our most vulnerable citizens is not the path to success.
We look forward to working with you to preserve the Medicare program while preserving access to rehabilitation services for all Medicare beneficiaries. Thank you for the opportunity to submit this testimony for the written record. For more information, please contact Peter Thomas at firstname.lastname@example.org or (202) 872-6730.
American Academy of Physical Medicine and Rehabilitation
American Congress of Rehabilitation Medicine
American Medical Rehabilitation Providers Association
American Music Therapy Association
American Occupational Therapy Association
American Physical Therapy Association
American Speech-Language-Hearing Association
American Therapeutic Recreation Association
Association of Academic Physiatrists
Association of Rehabilitation Nurses
Brain Injury Association of America
Center for Medicare Advocacy
Christopher & Dana Reeve Foundation
National Association of State Head Injury Administrators
National Association for the Advancement of Orthotics and Prosthetics
National Disability Rights Network
Paralyzed Veterans of America
The Arc of the United States
United Spinal Association
US Department of Health and Human Services (HHS) Issues Message to Our Nation’s Health Care Providers
HHS has issued a letter to health care providers to ensure that they are aware of their ability under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to take action, consistent with their ethical standards or other legal obligations, to disclose necessary information about a patient to law enforcement, family members of the patient, or other persons, when they believe the patient presents a serious danger to himself or other people.
Sequestration and Fiscal Cliff - FAQs and What You Can Do
What is Sequestration?
The Budget Control Act of 2011 (P.L. 112-25) established caps on discretionary spending over 10 years, resulting in $1 trillion in cuts spread across defense and non-defense discretionary programs. The law also directed a congressional Joint Select Committee on Deficit Reduction to identify an additional $1.2 trillion in budget savings over ten years.
The failure of the bi-partisan "super committee" to come to an agreement on a deficit reduction plan, triggered a "sequester" to take effect on January 2, 2013. Sequestration will mean an automatic 8.4 percent cut to program funding levels for most non-defense discretionary programs.
Non-defense discretionary or "NDD" programs are core functions that the U.S. federal government provides for the benefit of all, including medical and scientific research; education and job training; infrastructure; public safety and law enforcement; public health; weather monitoring and environmental protection; natural and cultural resources; housing and social services; and international relations.. These cuts will truly be across-the-board, with no departmental or agency control on how the sequester impacts individual programs.
What is the Fiscal Cliff?
The fiscal cliff is a combination of federal tax and spending legislation that must be addressed very quickly (within the next month). Tax cuts, including the so-called Bush tax cuts, are set to expire soon. Congress will have to figure out whether to extend them, and if so, which ones to extend. These proposed tax cuts combined with the looming spending cuts are essentially what equates to the fiscal cliff.
How does this affect me?
Most music therapists work in settings that will be affected by pending sequestration cuts. Whether you are working in a hospital setting, a school setting, a VA program, or even if you are self-employed; it is almost guaranteed that the spending cuts proposed to correspond with sequestration will affect you directly.
What happens now?
Lawmakers will be working to come to a compromise. Most expect that they will be able to reach some sort of temporary deal before the end of the year. Unfortunately, that is far from a sure thing.
What can you do?
· Use the contact as an opportunity to educate. Let your representatives know that you are a practicing music therapist living / working in their district. Name your facility or neighborhood.
· Express your concerns about the looming crisis and request that they work to find a balanced and bi-partisan approach to solving America’s fiscal issues.
· Let your representative know that you plan to pay attention to how they respond to this issue and will be in touch once any changes or decisions are made.
This is a great opportunity to "make your voice heard" to your Federal legislators and make it known that concern about the fiscal crisis is a reality within their constituencies.
If you have any additional questions, please feel free to contact Rebecca Smith, AMTA Government Relations Associate, email@example.com
Department of Labor - Employment and Training Administration (ETA), Allied Health Competency Model
"The mission of the Employment and Training Administration is to contribute to the more efficient functioning of the U.S. labor market by providing high quality job training, employment, labor market information, and income maintenance services primarily through state and local workforce development systems." (http://www.doleta.gov/etainfo/mission.cfm)
The Employment and Training Administration (ETA) has worked with technical and subject matter experts from education, business, and industry to develop a comprehensive competency model for the Allied Health industry sector. The model identifies the knowledge, skills, and abilities needed for workers to perform successfully in the field of Allied Health.
AMTA Government Relations Director, Judy Simpson, participated as a Subject Matter Expert (SME) for ETA's Industry Competency Initiative for Allied Health. AMTA also served as a Validator and Industry Champion in the Model development process. Ongoing collaboration with the Health Professions Network (HPN) was instrumental in AMTA's participation in this project.
National Endowment for the Arts (NEA) Releases White Paper on Arts and Human Development
The National Endowment for the Arts is leading a new task force of 13 federal agencies and departments to encourage more and better research on how the arts help people reach their full potential at all stages of life. The new task force will look for ways to facilitate discussion, showcase, and share recent research on the arts and human development. A white paper titled "The Arts and Human Development: Framing a National Research Agenda for the Arts, Lifelong Learning, and Individual Well-Being," has been developed to examine the relationship between the arts and positive health and educational outcomes at various segments of the lifespan -- from early childhood, to youth and adolescence, to older adult populations. AMTA was invited to participate in the introductory webinar and will be contributing to the collection process as it moves forward.
Institute of Medicine (IOM) - Allied Health Workforce Workshop Summary Released
Earlier this year, the Institute of Medicine (IOM) held a two-day meeting titled, "Workshop on the Allied Health Workforce and Professions." The workshop was intended to examine the current allied health care workforce and consider how that workforce contributes to solutions for improving access to health care services, particularly for underserved, rural, and other populations.
Content included a discussion on the definition of the allied health workforce and improving workforce strategies geared towards increasing access to allied health services. Attention was focused on raising awareness for policy makers, state and local governments, and allied health care providers to improve regulations related to allied health care delivery.
HPSO - Risk Advisor Newsletter
The HPSO Risk Advisor is published as an added benefit for the insurance customers of Healthcare Providers Service Organization. The Risk Advisor shares articles of interest, answers to frequently asked questions and actual case studies. Please click here for more information