what is crt visits prep 5-1-19.pdfwhat crt is and highlights the 2 issuesandbills • crt wheelchair...

2019 CRT Conference Congressional Visits Prep ‐ May 1, 2019

1

Congressional Visits Preparation

National CRT Conference

May 1, 2019

Don Clayback

Executive Director, NCART

• Medically necessary and individually configured:‐‐ Specialized manual and power wheelchair systems

‐‐ Seating and positioning systems

‐‐ Other adaptive equipment (standing devices, gait trainers)

• Requires evaluation, configuring, fitting, adjustment, training, or programming

• Provided through an interdisciplinary clinical and technology team (physician, therapist, ATP, others)

• Designed to meet the individual's unique medical, physical, and functional needs

2

What Is CRT

1

2


2

Steps In Congressional Advocacy

3

Step 1 ‐ Get informed on issue and solution (and stay informed as things move forward)

Step 2 ‐ Educate your Members on the issue, your “STORY”, and directly communicate the “ASK”

Step 3 ‐ Follow up until you get a “YES” or “NO”; if NO understand why (and don’t accept brush‐offs)

Step 4 ‐ Get others to get engaged and do the same

Federal Legislative Road Map

4

1) Introduce bill (ideally in both Senate and House) and secure as many cosponsors as possible

2) Work with key committee staff to address questions and get Committee approval

3) Bill needs to be officially scored (costed) by the Congressional Budget Office (CBO)

4) Ultimate goal‐ get bill attached to larger Medicare or healthcare legislation; passed in both chambers; and signed by President

3

4


3

Begin With The End In Mind

• You have 1 Representative and 2 Senators in Congress

• One star earned as you get each of your Members to sign as cosponsor to CRT bills

• Get all 3 of your Members signed on and you’re a “3 Star CRT Advocate”

5

Polite Persistence Wins

• CRT advocacy is not a one‐time action

• You’re creating a relationship that involves two steps: (A) educate on what CRT is; then (B) ask for and secure what you need

• Polite Persistence‐ being personal, credible, and professional; staying on task until you secure your ultimate objective

6

5

6


4

• CRT is critical to people with high level disabilities; meets medical needs; maximizes independence; lowers healthcare costs

• Small population of people/products that need distinction (only 15% of Medicare wheelchair users)

• Bills will protect/improve CRT access and elevate standards and safeguards for Medicare and beneficiaries

• Strong bipartisan Congressional support and broad support from consumer/medical professional groups

Congressional CRT Talking Points

7

• Increases function and independence

• Reduces health care costs– Reduces medical complications and interventions

» Skin pressure injuries

» Orthopedic complications

» Respiratory, digestive, circulation issues

– Reduces hospitalizations and institutionalizations

– Reduces need for caregiver assistance

8

Benefits of CRT

7

8


5

9

Complex Manual WCs - 9% of Medicare• Intended for long-term use• High Adjustability• Provides Positioning• Accommodates Orthopedic Needs• Provides Pressure Management

Standard Manual WCs - 91% of Medicare• Intended for short-term use• Minimal to Zero Adjustability• Provides NO Positioning• NO Accommodation of Orthopedic Needs• Provides NO Pressure Management

Manual WCs ‐ Complex vs. Standard

10

Complex Power WCs - 44% of Medicare • NOT what’s advertised on TV • Intended for Progressive Diagnoses• Advanced Electronics and Controls• Provides Positioning• Accommodates Orthopedic Needs • Provides Pressure Management• Offers Ventilator Accommodation

Standard Power WCs - 56% of Medicare • Intended for Ambulatory Limitations• Basic Joystick Drive ONLY• Provides NO Positioning• NO Accommodation of Orthopedic Needs• Provides NO Pressure Management• NO Ventilator Accommodation

Power WCs ‐ Complex vs. Standard

9

10


6

• Over 50 national groups signed on – all the biggies:

ITEM Coalition, United Spinal Association, National Multiple Sclerosis Society, ALS Association, Muscular Dystrophy Association, National Council on Independent Living, Paralyzed Veterans of America, Christopher and Dana Reeve Foundation, Spina Bifida Assoc, American Association of People with Disabilities, and others

• Full list of groups available on website

11

Support from National Consumer/Clinician Groups

2018 Federal Recap

• CRT Manual Wheelchair Accessories Bill

• CRT Separate Benefit Category Bill

• November election results

• Year‐End Legislative Push:– Able to get CRT Manual Wheelchair Bill added to small Medicaid bill on 12/6…H.R. 7217

– Overwhelmingly passed in House 400‐11 on 12/11– Stalled in Senate (not due to CRT) and was not acted on before they adjourned for the year

12

11

12


7

2019 CRT Congressional Asks

1) Pass CRT Manual Wheelchair bill‐

Stop Medicare’s inappropriate use of DME Competitive Bid rates to cut payment for accessories (critical components) and Exempt CRT manual wheelchairs from inclusion in the CB program

2) Pass CRT Separate Benefit Category bill‐

Create Separate Benefit Category (SBC) for CRT within Medicare and implement needed improvements in coverage, coding, and standards

13

2019 CRT Manual Wheelchair Bill

14

• House bill H.R. 2293‐ led by Reps. John Larson (D‐CT) and Lee Zeldin (R‐NY). Ended 2018 with 123 cosponsors (62 Ds and 61 Rs); 17 on Ways & Means Committee, 18 on Energy & Commerce Committee.

• Senate bill S. 1223‐ led by Sens. Bob Casey (D‐PA) and Rob Portman (R‐OH). Ended 2018 with 25 cosponsors (11 Rs and 14 Ds); 9 Finance Committee, 4 on HELP Committee.

13

14


8

Details of CRT Manual WC Bill

15

• 18 month suspension of Medicare inappropriately applying Competitive Bid pricing to CRT wheelchair accessories (a/k/a critical components)

• Clarifies Congress’ intent to exclude CRT manual wheelchairs from the DME Competitive Bidding Program

• CMS made policy correction for CRT “power” accessories in 2017 – BUT DID NOT EXTEND THAT TO CRT “MANUAL” ACCESSORIES

2019 CRT Separate Category Bill

• House bill H.R. 2408‐ led by Reps. Jim Sensenbrenner (R‐WI) and Brian Higgins (D‐NY). Ended 2018 with 116 cosponsors (75 Ds and 41 Rs); 12 on Ways & Means Committee, 16 on Energy & Commerce Committee.

• Senate bill‐ Looking for new 2019 Senate champions. Ended 2016 with 19 cosponsors (9 Rs and 10 Ds).

16

15

16


9

Details of SBC Bill “Version 2.0”

• Creates separate category for CRT within the Medicare DMEPOS benefit (similar to Orthotics & Prosthetics)

• Designates specific HCPCS codes as CRT and allows for creation of NEW dedicated codes to segregate CRT

• Eliminates “in‐the‐home restriction” for CRT and adds functional considerations

• Increases supplier standards: ATP plus “enhanced credential”, repair capability requirement

17

• Congressional Budget Office (CBO) gives “official” financial cost; estimate based on a 10 year projection

• CRT Manual Wheelchair Bill – 2018 CBO score of $10 Million

• CRT Separate Benefit Category Bill – No CBO score yet; 2011 actuarial firm estimate of $56 Million; does not include the impact of “savings” from improved access to CRT

“Cost” of CRT Bills

18

17

18


10

• House “Medicare” Committees‐

– Ways & Means Committee

– Energy & Commerce Committee

• Senate “Medicare” Committees‐

– Finance Committee

– HELP Committee (Health, Education, Labor, Pension)

19

Key Health Care Committees

Meeting

With Congress

20

19

20


11

Advocacy ‐ Polite Persistence

• Focus on your specific ask

– Sign on to the bill as a cosponsor and

help pass our legislation this year

• Don’t get sidetracked by “blow off” responses

whether via email or in‐person – you don’t want

them to “keep your request in mind” – you want

them to cosponsor the bill

• Polite and persistent follow up will pay off

21

• Attendee Materials‐ for your use only

• Leave‐Behind Materials‐ what you will leave with the Congressional offices; note‐ only one Leave Behind Folder per appointment.

22

Congressional Visit Materials

21

22


12

• Congressional Visits Info and Tips‐ lists buildings, cafes, meeting protocols, and contact numbers

• Capitol Hill Map‐ shows locations of buildings and accessible entrances

• Position Paper on Complex Rehab Wheelchair Bill‐provides details of bill and who to contact to sign on

• Position Paper on CRT Separate Benefit Category‐provides details of bill and who to contact to sign on

• Congressional Visit Report

Attendee Materials

23

• Lists time, location, and who you will bemeeting with

• If you are running late or have to cancel please call and let the office know

Appointment List

24

23

24


13

• 2019 Congressional Asks‐ cover page that introduces what CRT is and highlights the 2 issues and bills

• CRT Wheelchair vs Standard Wheelchair Pictorial‐use to give visual of how CRT is different

• Complex Rehab Wheelchair Position Paper‐ provides details of bill and who to contact to sign on

• Separate Category Position Paper‐ provides details of bill and who to contact to sign on

Congressional Leave Behind

25

You’ll likely have 20 to 30 minutes…..

1) Who You Are

2) What’s The Problem

3) What You Need Them to Do

4) Let Them Respond

5) Establish Next Steps

Segments of Your Meeting

26

25

26


14

• Targets‐ your 1 Representative and 2 Senators

• You may actually meet with a staff person which is fine (and may be preferable)

• Remember, they WORK FOR YOU

• Your Member looks at you as votes‐ so mention yourself and OTHERS you can influence

• The challenge is to convey your message concisely and GET WHAT YOU NEED

27

Meeting Tips

• Keep your message concise and personal

• Relate issues to the Member’s constituents

• Avoid jargon and acronyms

• If asked a question and you don’t have an answer just say so….and get back to them

• This meeting is NOT A ONE TIME EVENT….build relationship with the Member/staff

28

Meeting Tips (cont’d)

27

28


15

1) Show up a few minutes early

2) Be ready to present and close in 15 minutes

3) Decide ahead of time who is lead speaker

4) Go to receptionist desk, give business card, tell them who you are there to see

5) You may meet in a variety of settings‐ the office, a meeting room, the hallway, etc.

6) Keep in mind you are one of many meetings that day (be distinctive!)

29

Meeting Protocol

7) The finish is critical; leave time to conclude and focus on next steps‐

• Restate what you need and ASK FOR THE ORDER

• If meeting with staff, they will not commit their boss but should agree to discussing it with him/her

• Gauge level of support (note in your Visit Report)

• GET THEIR BUSINESS CARD for contact information

• Thank them for their time and let them know you will be following up

30

Meeting Protocol (cont’d)

29

30


16

• Be sure you understand the basis for the comments

• Respond constructively – never burn a bridge

• If appropriate, respond to the points made with an alternative view/facts

• If appropriate, offer to follow up with additional information

31

Handling Negative Feedback

• Use as a tool to document your meeting

– Who you met with (get a card)

– What was the outcome (yes, maybe, no)

– What follow up is needed

• Use as a tool to manage your follow up

– Emails

– Phone calls

– District office visit

32

Congressional Visit Report

31

32


17

Follow Up

33

• Your meeting is meant to either begin a relationship or help build on an existing one

• Send a “thank you” email the following week, supply any additional information, and pursue a visit to your business/facility

• Remember, POLITE PERSISTENCE wins the day!

34

Follow Up Is Critical

33

34


18

• Keep us posted on your progress and any additional information you need

• We’ll be updating everyone as new cosponsors are officially signed on

• We’ll be providing periodic brief “CRT Updates” to email to your contacts during the course of the year to keep communication ongoing

35

Help Is Available

Unacceptable Cosponsor “Brush‐Offs”

36

• I support people with disabilities and promise to “keep your comments in mind”

• I’m not on the Committee of jurisdiction

• I will monitor this bill when it comes to the floor

• I need a CBO score before I can sign on

• I have already signed on to ________

We need active support by the Member signing on as a bill cosponsor….don’t burn bridges, but be assertive!

35

36


19

37

State Scoreboard

Members: House of Representatives 435; Senate 100

Thanks For Your Attention

38

Don Clayback

Executive Director, NCART

716‐839‐9728 [email protected]

37

38

what is crt visits prep 5-1-19.pdfwhat crt is and highlights the 2 issuesandbills • crt wheelchair...

Documents