Legislative Update
WARN Legislative Update
July 2011
By Judy Klaver
Wisconsin Nursing Coalition Update
The Coalition met May 26th the minutes of that meeting are pending. The next meeting of the Coalition will be in September.
Related News
A bill to repeal Outpatient Physical Therapy Caps is introduced.
WASHINGTON – U.S. Senator Ben Cardin (D-MD) today (April 14th) joined U.S. Senator Susan Collins (R-ME) to introduce legislation to ensure appropriate access to outpatient rehabilitation services under the Medicare program.
The bill would repeal the existing annual caps on physical therapy, occupational therapy, and speech-language pathology services.
“Arbitrary caps on vital Medicare services outpatient therapy have no place in medicine,” said Senator Cardin. “These caps fail to take into account patients’ medical needs. If Congress fails to act, they will have a serious effect on the progress of seniors who are recovering from strokes, hip fractures, or other serious medical conditions.”
Limits on outpatient rehabilitation therapy in Medicare were first imposed in 1997 as a budget-saving measure. They were adopted without hearings and with no policy justification for the then-$1,500 limits. Over the years, Congress has acted numerous times to prevent the caps from going into effect, most recently by extending an exceptions process for one year in the Medicare and Medicaid Extenders Act of 2010.
“I am concerned that Medicare beneficiaries recovering from a stroke, hip fracture, or other disease or condition requiring extensive therapy will not be able to receive all of the services they need under these caps” said Senator Collins. “Moreover, Medicare patients would have an incentive to seek services in the hospital outpatients setting, which are not subject to the caps and are more expensive.”
The Medicare Access to Rehabilitation Services Act of 2011 would guarantee beneficiaries access to physical and occupational therapy and speech-language services. Without further congressional action, the caps will take effect on January 1, 2012. Arbitrarily capping these vital rehabilitation services would cause some beneficiaries to delay necessary care, force others to assume higher out-of-pocket costs, and disrupt the continuum of care for many seniors and persons with disabilities.
If fully enforced, this policy would present a major hurdle to beneficiaries receiving the critical rehabilitation care they require to deal with an illness, such as Parkinson’s disease or stroke, or a debilitating injury such as a hip or joint fracture.U.S. Congressmen Xavier Becerra (D-CA) and Jim Gerlach (R-PA) also will be introducing a similar measure today in the U.S. House of Representatives. Repeal of the Medicare therapy caps is supported by more than 30 organizations, including: the American Physical Therapy Association, the American Occupational Therapy Association, the American Association of Homes & Services for the Aging, the American Association of People with Disabilities, the American Heart Association/American Stroke Association, and the Autism Society.
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House Armed Services Committee Adopts TBI Amendment
On May 11, 2011, Rep. Todd Russell Platts (R-PA), co-chair of the Congressional Brain Injury Task Force, working in collaboration with the office of Congresswoman Gabrielle Giffords (D-AZ), Task Force members and the Brain Injury Association of America, introduced an amendment to the National Defense Authorization Act that authorizes $1 million for the development of treatment guidelines for post-acute rehabilitation of traumatic brain injury. The amendment was adopted en bloc by the full House Armed Services Committee by voice vote.
Despite the many advances in science and medicine, medical treatment guidelines for post-acute rehabilitation of moderate and severe TBI do not exist. Currently, there is no compilation of the published evidence and professional consensus to ensure that wounded warriors and the 1.7 million civilians who sustain brain injuries in the U.S. each year receive the highest quality, most effective post-acute rehabilitation.
“The absence of treatment guidelines contributes to the substantial inconsistencies in health insurance coverage for TBI care," said Dr. Brent Masel, national medical director for the Brain Injury Association of America.“The inconsistencies make it difficult for people to get the care they need to live healthy, independent and productive lives.”
The inconsistencies in insurance coverage also create a challenge for the U.S. Department of Health and Human Services. The Patient Protection and Affordable Care Act charges the agency with writing regulations for essential health benefits based on a “typical employer plan.” Since there are no typical insurance plans for TBI, advocates argue the essential benefits for rehabilitation should be based on standardized treatment guidelines that reduce long-term disability and mitigate against the chronic disease processes that result from a traumatic brain injury.
“Congress has acknowledged that traumatic brain injuries from blast exposures are the signature injury of the wars in Iraq and Afghanistan,” said Rep. Platts. “It is more important than ever that we do right by the men and women in our military who serve in harm’s way to ensure that they receive the highest quality of medical treatment available in order to lead meaningful and productive lives post-injury.”
BIAA thanks our congressional partners in this effort, including Congressmen Platts and Pascrell, the office of Congresswoman Giffords, and the House Armed Services Committee. BIAA will continue to follow the provision throughout the process of passing the FY12 National Defense Authorization Act and alert grassroots advocates if any action becomes necessary.
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Comparative Effectiveness Review on TBI and Depression
The Agency for Healthcare Research and Quality recently concluded a study on the relation between traumatic brain injury (TBI) and depression. The study found that the risk of depression is higher for those who have suffered from TBI and that the higher risk continues for an extended period of time after the injury has occurred. More research on which kinds of treatment are appropriate for individuals with TBI and depression is needed. Read more at AHRQ.gov. http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-andreports/?pageaction=displayproduct&productid=657
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1.2 Million Young Football Players Need Concussion Laws
Several states have recently passed laws requiring student athletes to be cleared by a medical professional before returning to play when it is suspected that they have suffered a concussion. Many other states, particularly those where football is a popular sport, have passed weak or no legislation regarding this issue. Most tend to be concerned that the lack of attention on the danger of concussions borders negligence on the part of lawmakers, but others have apprehensions about such laws, saying they are too restrictive on players in rural areas who might have to travel over an hour to visit a physician in order to be cleared to play. Read the full USA today article from April 14, 2011
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After Brain Injuries, Troops Hit the Mental Gym
The military is using computerized brain training programs to help individuals who have suffered a traumatic brain injury (TBI). Just as wounded troops need physical rehabilitation, those suffering from TBI need mental rehabilitation. The computer programs, which are easily accessible from anywhere that has internet access, involve tasks that require remembering words, or details in a picture, in order to counteract memory loss. Read the full story from National Public Radio bellow.
After Brain Injuries, Troops Hit The Mental Gym by Jon Hamilton May 12, 2011
Wounded troops often spend months in physical therapy to regain strength in their damaged bodies. Now, the military is trying something similar for military personnel with injured brains.
The Department of Defense is using computerized brain training programs to help personnel with traumatic brain injuries.
The approach is intended for people like 1st Lt. Frederick Simpson.
About a year ago, Simpson was knocked unconscious by the explosion of a rocket-propelled grenade during a firefight in Afghanistan. He was also struck by a bullet that shattered his left shinbone.
Over the next few months, doctors at Walter Reed Army Medical Center in Washington rebuilt his leg. But Simpson says there wasn't any operation to fix what the explosion had done to his brain.
"I would get confused," he says. "I had real poor short-term memory — real poor long-term memory, for that matter. I had trouble staying focused. I would be talking to somebody and then I would just kind of drift off."
Simpson would also forget where he was going or whether he'd turned off a burner on the stove. So he started visiting the Brain Fitness Center at Walter Reed. It's one of several centers set up by the Defense Department in the past few years to help people with brain injuries recover.
Working Your Brain To The Limit
The center at Walter Reed isn't much to look at: It's a small, interior room with a half-dozen computers running programs that look and sound a bit like video games.
The games involve tasks like remembering words or details in a picture or figuring out what a distorted voice is saying. And for people like Simpson, they can be as grueling as any physical workout.
"I don't like coming in," he says. "But I do because I know it works. It's beneficial for me."
Simpson does four 15-minute sessions a day. He says even those short sessions are enough to cause headaches and frustration.
"Some days you just want to crush the mouse 'cause you just can't get it," he says. "It's all on the tip of your mind, but it just won't come. And sometimes your mind has a breakthrough and you can really kind of skate through all the exercises."
Some days you just want to crush the mouse 'cause you just can't get it. It's all on the tip of your mind, but it just won't come. And sometimes your mind has a breakthrough ...
- 1st Lt. Frederick Simpson, who was injured in Afghanistan last year, on the impact of brain training exercises
The brain fitness programs are a lot like physical rehabilitation, says Katherine Sullivan, a speech pathologist who directs the Brain Fitness Center. The idea is to work your brain to the limit, she says.
"Just like going to a gym, you could stay here for 30 minutes and not really get a great workout," she says. "But sometimes if you push yourself to that threshold that's ideal and optimal for training, you're going to see more benefit."
Some of the computer programs at the center are the same ones sold to consumers trying to sharpen their memory or thinking. Others are more ambitious efforts from companies studying how best to strengthen an injured brain.
Sullivan says the people who use them often say things like "I feel more confident going out and doing things. I feel a little bit more like myself. I'm thinking maybe a little quicker." Some even say "my marriage seems a little better," she says.
'Most Of These People Can Be Substantially Better'
One reason the military likes the computer-based approach is that soldiers can work on the their brains anywhere they have a computer and a connection to the Internet, Sullivan says.
But scientists caution that brain training remains experimental.
"These training programs are a work in progress," says Michael Merzenich, a professor emeritus and neuroscientist at the University of California, San Francisco. Merzenich is also a co-founder of Posit Science, a company that makes one of the brain training programs used at Walter Reed and other military and veterans hospitals.
Merzenich says he is confident that brain training, like physical training, is doing something.
"That doesn't mean that everyone is going to be in the tip-top shape they were in before they went over to Afghanistan," he says. "But most of these people can be substantially better."
However, the effectiveness of most brain training programs hasn't been tested scientifically on normal brains, let alone injured ones, Merzenich says.
There are studies under way at Walter Reed and other institutions. The goal is to find out just how much difference a particular program makes and how it compares with other programs, Merzenich says.
"You don't just evaluate whether or not they improve in the specific task you're training them on," Merzenich says. "Of course they improve at those. The question is whether they improve in their general abilities that reflect their capacities, their operational abilities in everyday life. Because if you don't improve that, you've done nothing useful."
Simpson says brain training has been useful for him. His memory and ability to focus have improved enough that he can now travel on his own without worrying about getting lost, he says.
And Simpson says he plans to keep training his brain so he'll eventually be able to attend nursing school.
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WHO Report on Disability
The first ever World report on disability, produced jointly by WHO and the World Bank, suggests that more than a billion people in the world today experience disability.
People with disabilities have generally poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their everyday lives.
The report provides the best available evidence about what works to overcome barriers to health care, rehabilitation, education, employment, and support services, and to create the environments which will enable people with disabilities to flourish. The report ends with a concrete set of recommended actions for governments and their partners.
This pioneering World report on disability will make a significant contribution to implementation of the Convention on the Rights of Persons with Disabilities. At the intersection of public health, human rights and development, the report is set to become a "must have" resource for policy-makers, service providers, professionals, and advocates for people with disabilities and their families.
For the full report go to: http://www.who.int/disabilities/world_report/2011/en/index.html
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Study Confirms Concussion Dangers to Young Athletes
A recent study published in Pediatrics highlights the dangers of repeat head injuries for athletes age 21 and younger. The authors reviewed cases of young athlete deaths that occurred due to a blow to the head or neck after suffering a concussion within the previous 4 weeks. Fourteen percent of the total 1,827 sudden athlete deaths from 1980-2009 were caused by trauma-related injuries. View full USA Today article at:
http://yourlife.usatoday.com/health/medical/story/0/study-affirms-concussion-dangers-to-young-athletes/48646702/1
Past Legislative Updates
May 2011 update
December 2010 update
May 2010 update
Februrary 2010 update
Fall 2009 update