1. American Association for Respiratory Care PACT MEETING Marriott DFW Airport North Sunday, March 30, 2008 Miriam O’Day (oday@aarc.org)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 4 th 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. Partnership - Healthcare Professionals Extending Benefits Access to Respiratory Therapists for Medicare Beneficiaries Under Part B HR 3968 Senate Companion S 2704 Medicare Respiratory Therapy Initiative

16. 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 Medicare Respiratory Therapy Initiative

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

18. 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 Medicare Respiratory Therapy Initiative

19. 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 Medicare Respiratory Therapy Initiative

20. 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 Medicare Respiratory Therapy Initiative

21. 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 Medicare Respiratory Therapy Initiative

22. 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 Medicare Respiratory Therapy Initiative

24. 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 Medicare Respiratory Therapy Initiative

25. 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 Medicare Respiratory Therapy Initiative

26. 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 Medicare Respiratory Therapy Initiative

27. 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 Medicare Respiratory Therapy Initiative

28. 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 Medicare Respiratory Therapy Initiative

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

30. 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 Medicare Respiratory Therapy Initiative

31. 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 Medicare Respiratory Therapy Initiative

32. 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 Medicare Respiratory Therapy Initiative

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

34. 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 Medicare Respiratory Therapy Initiative

36. 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 Medicare Respiratory Therapy Initiative

38. 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 Medicare Respiratory Therapy Initiative

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

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

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

42. DISCUSSION QUESTIONS RECOMMENDATIONS