03/11/2025 Emergency Lemonade: Worried About Medicare & Medicaid?

Summary

In a video presentation by PEDS-A-PALOOZA, healthcare professionals gather to discuss the urgent impending changes in Medicare and Medicaid. Nancy Mira, the founder of PEDS-A-PALOZA, hosts the event, emphasizing the necessity for adaptation due to upcoming policy shifts. Key speakers, including Caroline Berner and Sarah Warren from healthcare policy organizations, outline how these changes could potentially impact practitioners and clients. With the government's new budget and policies under President Trump, professionals in various therapy fields must brace for shifts in regulations and funding structures, challenging them to continue providing care despite potential reductions and adjustments in Medicaid and Medicare funding.

Highlights

• Announcement of imminent changes in Medicare and Medicaid affecting diverse healthcare professionals. 📢
• Discussions on advocacy and potential impacts on patient care. 👥
• Strategies for adaptation and stabilization amidst financial constraints highlighted. 🔄
• Preparation for reduced resources and increased workload noted. ⚙️
• Importance of political advocacy and engagement stressed to influence policy outcomes. 🗳️
• Upcoming events and resources to help professionals manage changes. 📆

Key Takeaways

• Shifting Policies: Major changes to Medicare and Medicaid are on their way, impacting funding and regulations for healthcare providers. 🚧
• Brace for Change: Healthcare professionals need to prepare for adjustments and do more with fewer resources. 🌊
• Action Plan: Emphasize advocacy and stay informed through organized efforts like the upcoming Palooza event in April. 📋
• Stay Informed: Following legislative developments can equip professionals with the tools needed to adapt and thrive amidst these changes. 🔍
• Diversify: Expanding income sources is essential for stability in the shifting healthcare landscape. 🌐

Overview

In this insightful and urgent discussion, Nancy Mira brings together healthcare pros to discuss critical updates regarding Medicare and Medicaid. With nearly 400 participants at the emergency webinar, it sets the stage for understanding and proactive strategizing amidst governmental policy changes.

The session features insights from healthcare policy experts like Caroline Berner and Sarah Warren, detailing how upcoming alterations in healthcare funding could affect services provided by audiologists, speech language pathologists, and more. They explore the budgetary pressures under President Trump's administration that may lead to substantially modified funding structures.

Participants are encouraged to act by staying informed, engaging in advocacy, and attending the Palooza event in April dedicated to addressing these systemic shifts. The emphasis is on doing more with less and preparing strategies for maintaining service delivery despite expected financial tightenings.

Chapters

• 00:00 - 01:30: Introduction and Webinar Context The chapter opens with a lively atmosphere, characterized by music and anticipation for a 'Hot Topic' discussion. The speaker mentions that the webinar has attracted a substantial number of participants, with nearly 400 people registered. They also note that some attendees will watch the session as a recording later.
• 01:30 - 02:30: Nancy Mira's Introduction In the chapter titled 'Nancy Mira's Introduction,' the speaker discusses the urgency and importance of quickly disseminating the recorded information due to its time-sensitive nature. The recording, referred to as an 'emergency lemonade,' suggests an unusual context or metaphor emphasizing the need for prompt action. The speaker assures listeners that the material will not be delayed, especially considering that it is essential information for the audience, possibly related to Medicaid and Medicare charge changes affecting areas like pediatrics. The speaker expresses appreciation to those present and promises comprehensive coverage of the topic.
• 02:30 - 03:30: Overview and Motivational Message Nancy Mira introduces herself as the founder of multiple organizations including Pizza Palooza, the Private Practice Network, and Odds in a Pod. She mentions the involvement of various professionals such as audiologists and emphasizes her broad coverage of private practice for both pediatric and adult audiences.
• 03:30 - 05:00: Introduction to Guests Caroline Berner and Sarah Warren The chapter introduces guests Caroline Berner and Sarah Warren, highlighting an underlying theme of upcoming changes. Emphasis is placed on maintaining a motivational outlook, embodying a mindset where no effort is spared, in line with the wisdom imparted by the speaker's mother.
• 05:00 - 08:30: Discussion on Medicaid The chapter focuses on a discussion about Medicaid, emphasizing the importance of being flexible and prepared for various scenarios. The speaker shares their personal mantra of expecting the best but preparing for the worst, acknowledging that changes won't happen overnight. There are inquiries at the state level, and upcoming events are noted as part of the discussion.
• 08:30 - 16:00: Sarah Warren on Medicare Update Sarah Warren discusses the upcoming Palo event scheduled for April 26 and 27. She plans to make significant adjustments to the agenda to address pressing issues on the state level. Her key message emphasizes the importance of acting promptly to stabilize and expand operations amidst current changes.
• 16:00 - 23:00: Medicaid Overview by Caroline Berner The chapter titled 'Medicaid Overview' features Caroline Berner, the director of Health Care policy for Medicaid. In this section, the speaker emphasizes the reality of achieving more with fewer resources, despite it being an uncomfortable truth. Caroline Berner is introduced along with Sarah Warren, who is also a director of Health Care policy. The discussion appears to touch upon challenges and strategies related to Medicaid policy management.
• 23:00 - 27:00: Budget Reconciliation Process The chapter discusses the Medicare budget reconciliation process, highlighting contributions from both sides of the political spectrum. The discussion is led by Caroline, who outlines the key points and actions being taken. The session starts with Caroline due to her needing to leave early.
• 27:00 - 31:00: House and Senate Plans for Medicaid Cuts The speaker discusses the importance of overcoming uncertainty, emphasizing that not knowing can be detrimental, comparing it to being caught by the Achilles heel. They advise finding certainty and taking decisive action to mitigate uncertainty, acknowledging that the conclusion is unclear, and thus highlights the challenge of dealing with uncertainty.
• 31:00 - 41:00: Impact of Proposed Changes on Medicaid This chapter opens with Caroline Berner introducing herself and Sarah Warren from the American Speech-Language-Hearing Association. They set the stage for discussing the proposed changes to Medicaid, with a focus on Audiology and Speech-Language Pathology services. The content is relevant to their member association, but the insights shared apply broadly across all medical domains. The speakers aim to cover specific subject areas but maintain a wide-ranging applicability to the healthcare sector overall.
• 41:00 - 49:00: Impact on Providers and School Settings This chapter revolves around the role and impact of therapies in both provider and school settings. It introduces a discussion on the implications of being salaried employees of an organization called ASHA, highlighting no financial disclosures besides their employment. The chapter also provides an insight into ASHA's government affairs and public policy initiatives, comparing it to other similar entities like APCA and OTAA, which have dedicated efforts towards these areas.
• 49:00 - 53:00: Asha's Advocacy Efforts Asha's advocacy efforts are supported by a team of 21 dedicated professionals who focus on government affairs, with an emphasis on speech-language pathologists and audiologists. The advocacy is structured at both state and federal levels. The team includes congressional lobbyists and members like Sarah, who focus on healthcare and education policy. They are recognized as regulatory policy experts and are instrumental in pushing state-level advocacy initiatives.
• 53:00 - 56:00: How Asha Members Can Help The chapter provides information on how members of Asha and related organizations such as APAA and AOTA can engage with their state associations and affiliates. It highlights the role of advocacy professionals in communicating important issues to members. The chapter also touches on proposed Medicaid cuts and their potential impact on members' practices.
• 56:00 - 65:00: Question and Answer Session The chapter "Question and Answer Session" delves into the concept of federalism and separation of powers within the U.S. government. The speaker reflects on how these principles have sometimes been overshadowed by proposed changes under new administrations. It recounts basic civics education about the three branches of government—executive, legislative, and judicial—and notes that, at the time of the discussion, President Trump is leading the executive branch.
• 65:00 - 67:00: Conclusion and Final Remarks The chapter discusses the different branches of the U.S. government and their respective roles. It highlights the administrative agencies like Health and Human Services, which are responsible for enforcing the law. It explains the legislative branch, consisting of the House of Representatives and the Senate, as a distinct and separate branch responsible for creating and writing laws. The transcript also refers to the executive branch with a mention of President Trump, showing the separation of powers where Congress functions independently. The chapter implies an overview of the judicial branch, though the transcript cuts off before elaborating.

03/11/2025 Emergency Lemonade: Worried About Medicare & Medicaid? Transcription

• 00:00 - 00:30 [Music] we we got a Hot Topic up in here my goodness we're gonna let people file in a little bit more we have almost 400 people on this webinar or at least registered the rest will um watch it in
• 00:30 - 01:00 the recording hopefully since it is a dang emergency lemonade we won't take um two weeks to get it edited and out to everybody because that won't make much sense um since it's 101 I don't like to penalize the people that got here and I want to make sure you got all the information so guys thank you this this uh Medicaid Medicare charges changes go across the board so I've got Pediatric
• 01:00 - 01:30 otpt Speech I've got um I've got audiologists on here I've got a gamut of people that are concerned about this so if you don't know me I'm Nancy Mira I'm the founder of pizza palooza I'm the founder of uh the Private Practice Network and the founder of odds in a pod so that pretty much covers all of Private Practice whether it's pediatric or adult um I just want to say before I introduce my fabulous last minute
• 01:30 - 02:00 willing to do this guests is that um overall guys it there are changes are coming and it is it's I want to give you my motivational aspect first is that one something can always be done you just have to be willing to as my mother would say have have no stone unturned number one and number two you
• 02:00 - 02:30 have to be willing to do other things and I've got some ideas on the other things because plan a plan a of this so my whole Mantra in life is expect the best prepare for the worst right so it might not be that great but there are things you're G to do it's not going to be overnight all right so let's let's get that straight although I I do have a bunch of questions on the state level but there are things that we can do okay so the paloa vent coming up I have a
• 02:30 - 03:00 feeling that with some things that I know that are happening on the state level that the Palo event April 26 and 27th I'm gonna tweak the heck out of the um the agenda to make it like a now what like now what okay because we got to get busy you got to get stable and you've got to get uh as stable as you can and expand and you're probably this is my message you're probably going to have to
• 03:00 - 03:30 do more with less resources you don't want to hear that all right let me introdu but it's a fact I could tell you what you want to hear but I always like to tell you what you need to know okay so my fabulous guest from Asha Caroline bergner and she's the director of Health Care policy for Medicaid and she's accompanied by The Fabulous Sarah Warren who is the director of Health Care policy for
• 03:30 - 04:00 Medicare so we've got both sides and there are um there are a lot of uh there's a lot to go so and then Caroline you have to jump off correct so we're gonna start with you yes is that what we decided I can't remember already okay good so um that's what we're doing okay so Caroline let us have it let us know what's happening and I just want to say
• 04:00 - 04:30 one other thing guys the not knowing my suggestion is the not really knowing is what's going to grab you by the Achilles heel okay so you're G to have to find certainty and action steps that put in certainty for yourselves because that's going to be the worst part okay is not knowing there's no I'm going to tell you right now the the end of this story is that we don't 100% know I'm going to shut up now Caroline you go thanks Nancy
• 04:30 - 05:00 uh it's a pleasure to be speaking with all of you all um my name is Caroline Berner as Nancy said um joining me is Sarah Warren from the American speech language hearing Association uh both of us will be speaking on our respective subject areas um but I will say Obviously our Focus thus far has been on Audiology and speech language pathology Services because that's our member Association however the um information that we're sharing will apply to all of
• 05:00 - 05:30 the therapies um equally so there's no sort of carve out for that um so next slide please Sarah fantastic so as I said per our um employer we have to have share that we are um salaried employees of Asha we have no Financial disclosures to um share other than that next slide Sarah thank you so I wanted to share a little bit about asha's government Affairs and public policy cluster um just like at apca and otaa there are dedicated
• 05:30 - 06:00 government Affairs professionals but for those of you all who are um speech language Pathologists um and potentially audiologists as well we have um a description of all the different folks who are working on advocacy at the state and federal level for you all on a day-to-day basis we have 21 dedicated professionals that are congressional lobbyists um my team which includes Sarah the healthcare and education policy folks we are the regulatory policy experts um and then we have state
• 06:00 - 06:30 affairs who are are folks who interact with our state associations um you have your state Affiliates for Asha so each one has their own SLP and odd organization but I know that for apaa and aota they have the state chapters that function verily very similarly we also have advocacy professionals that help us get the message um out to our uh members like you uh and I'm looking forward to sharing some information about how these proposed Medicaid Cuts may affect your practice going for forward next
• 06:30 - 07:00 slide so I want to talk a little bit about federalism and the separation of powers um some of this has been lost in a lot of the changes that have been proposed um as a new Administration has come into office um there are three branches of government you probably remember growing up and seeing that um as part of your Early Education as an American we have our executive branch and that's lead led by President Trump at this time but also so um as part of
• 07:00 - 07:30 that are the administrative agencies like Health and Human Services they are charged with enforcing the law the legislative branch is at the federal level again the Congress so you have your House of Representatives and Senate it's a separate Branch as much as we will hear in the news um that you know president Trump has uh has told Congress to do X Y or Z ultimately they are a separate branch of government um and they are charged with creating and writing the laws that we are all subject to Additionally you have your judicial
• 07:30 - 08:00 branch those are the Supreme Court and the federal court now the same kind of structure is then again imitated at the both state and local level I think this chart is super helpful to kind of break that down uh to see how each each separate area is is similar at each level of government in our country next slide please so I'm going to turn it over to Sarah for a brief Medicare update and then I'll come back for Medicaid after that
• 08:00 - 08:30 thanks Caroline and thanks um everyone for joining us today we're really pleased to try to um continue to share information with as broad an audiences that as we can um so I know that we talked uh this this webinar was sort of uh in the vein of what's going on with both Medicare and Medicaid and I recognize that there's probably people on this webinar who have a practice that goes across the life expand so
• 08:30 - 09:00 Pediatrics to um to geriatrics and so we want to give a little bit of information on Medicare but I think that most people my impression are probably more focused on the Pediatric population and so Medicare doesn't have necessarily a direct impact on pediatric populations primarily because of the way that it's structured it's it's designed to um help people who are 65 years of age or older and people people who have met the
• 09:00 - 09:30 Social Security Act definition of being permanently disabled there are definitely kids out there on Medicare it's a very very small percentage of the Medicare population um and so technically what happens with Medicare only uh is um only applicable to Medicare but we all know um I we often say this so goes Medicare so goes the nation a lot of private payers and State State Medicaid programs
• 09:30 - 10:00 do adopt Medicare policies and so we can't ignore the impact of Medicare but the important thing to remember is just because Medicare is doing it doesn't mean that a private payer has to do it or it doesn't mean that a State Medicaid Program has to do it um but we do want to kind of just talk a little bit about some of the big Medicare priorities that are happening you know really in the first half of this year um and there could always be some additional fun um
• 10:00 - 10:30 things that happen later on in the year but this is what we're working on in the in the short term um so I think the first thing is just understanding the impact of the numerous presidential executive orders that have been and will continue to be release and those have implications across such a broad um array they're they go even Beyond healthc care you know agriculture you know education they're really broad um and the Trump Administration is definitely making its uh Mark felt on
• 10:30 - 11:00 the federal government um and so we're just we have resources available on our website that outline some of the executive orders that are most relevant to audiologists and slps um I think if one that there's one takeaway from this is that these executive orders have a lot of um implications for folks both personally and professionally so like for example they clearly affect me professionally but I also have a child with special
• 11:00 - 11:30 needs and so they have personal implications for me and when we hear from our members I think we're hearing a lot of anxiety both from a personal you know what is this going to mean for me as a human to a professional what is this going to mean for me as a clinician so we're looking very closely at all of that and then in terms of Medicare I think the biggest Medicare issues that we are facing at this point are Medicare Part B payment reductions um those are those are the the party payment system
• 11:30 - 12:00 is for outpatient services so University clinics private practices Physicians offices anything that's billing outpatient type of services are impacted by these artificial reduction in the value of Audiology and speech language pathology Services as represented by the CPT codes that you guys bill and I think the thing to keep in mind is that the value of the CPT codes have not changed what has changed is that we're in a very very um tough fiscal environment and so
• 12:00 - 12:30 governments are looking to cut spending um and that's why we're seeing these Part B payment reductions and we're working very hard to address those the other big Medicare thing that we're looking at in 2025 is ensuring a robust permanent teleah health benefit at this time for those folks who are billing Medicare um that are non-physicians like pts OTs audiologists slps Medicare coverage of tahal services
• 12:30 - 13:00 will end on March 31st 2025 unless Congress passes a law extending the benefit um and I think there's a lot of anxiety about this at this point as of March 11th the only um legislative vehicle we have to address our priorities um and it's important to understand that you know it's because we have this March 31st deadline that we're so anxious about with telea health is the government funding bill that has to
• 13:00 - 13:30 be passed by this Friday the 14th um or else there will be a government shutdown um and so there could be additional legislative Vehicles down the road later in the year where we can attach our priorities but if we want something done by March 31st it's the government funding bill or bust so um we're looking at in the most uh the most recent legislative language around the government funding bill includes a
• 13:30 - 14:00 six-month extension of Medicare teleah health um again that would get us through September of this year September 2025 and um there are rumors that they will also include a fix for the part B payment Cuts but we haven't seen any legislative text when we went through this exercise in December because the government almost shut down over the holidays um it was literally like all every 30 minutes there was a new draft on the day the government funding bill had to be pass so we have a lifetime
• 14:00 - 14:30 between now and midnight on um Saturday uh March 15th um and there could be a lot of changes but this is sort of the state of play as of March 11th so we will see something on telea health what it will be at a minimum hopefully six months and hopefully a fixed to Part B Cuts remember if Medicare tele Health goes away on March 31st that technically has no implications for Medicaid State
• 14:30 - 15:00 Medicaid programs can continue to cover tele Health Beyond March 31st this deadline is only for Medicare patients or Medicare payments so with that I think I'm going to turn it back over oh I do want to just highlight sorry this is my bad how you can stay up to dat on what's going on with advocacy um I think there's three really important vehicles that you should be taking advantage of and this is for any advocacy related topic Medicare Medicaid education you name it if we're working
• 15:00 - 15:30 on it at Asha you're going to find it in these sources um the first is our advocacy news web page um I put the link here but if you just go to the main Asha web page you can see um our Asha advocacy section and our advocacy news page is housed through our our main advocacy page so when something happens we're going to write up a little story and it's going to be on our news web page the other is our Asha headlines
• 15:30 - 16:00 which is our email advocacy newsletter um again I've put the link um on this slide to sign up for that we try to use it sparingly only when there's something breaking that you really need to know about from an advocacy perspective you can also Google Asha headlines if you can't click on this link for some reason and it'll take you to our web page um to sign up for Asha headlines and finally um following us on social media um you know the Facebook
• 16:00 - 16:30 algorithms are not what they used to be um I don't see my friend's baby pictures anymore I see random videos go to Ash's main Facebook page don't wait for that algorithm to pop up in your feed um go to LinkedIn go to Twitter or X I should say go to Instagram um we're posting all of this information um when there's a major update through our social media feeds as well and now I swear to God I'm turning it over to Caroline thanks Sarah appreciate it um so I'll be
• 16:30 - 17:00 talking about Medicaid and Sarah I'm G to flag for you that there's a question in the chat that I think will be a couple of questions that will be helpful um for you to address thank you so first I'm going to talk a little bit about what is Medicaid a lot of us um you know I know you all many of you all build Medicaid uh and you're familiar with the program and how it works in your particular state but I do find that it's helpful to have establish a general floor for what everyone knows about Medicaid so it is a health insurance
• 17:00 - 17:30 program um it is for a like a a certain set of populations and there are a variety of Pathways to be eligible for coverage through the Medicaid Program low-income children adults and families pregnant women individuals receiving Social Security people with disabilities and children in foster care now there are certain populations that are optional for Medicaid programs to cover this um was created through the Affordable Care Act um as it pertains to low-income adult for example that's an
• 17:30 - 18:00 optional population that states choose to cover if they expand Medicaid so um your core Medicaid population are those people with disabilities low-income kiddos and um pregnant people um how is it funded so it is funded by both the state and federal government currently at this moment in time um it is funded via from the feds at the federal medical assistance percentage I'll call it the fmap from here here on out that fmap varies from anywhere between 50 to
• 18:00 - 18:30 83% and that's how much the federal government pays for Medicaid in a given state if a state has a large amount of folks who are enrolled in Medicaid they have a higher fmap percentage so they get more money from the federal government Mississippi is one I think the highest um fmap at around 83% of their Medicaid funds are paid for by the government um California on the other hand has a 50% fmap rate there are other states that are at that low amount as
• 18:30 - 19:00 well but I just share that as sort of two um examples of how that might work and whatever is not paid for by the federal government is then made up by the state government they get that money through a variety of different um methods taxes levies um you all will have heard about provider taxes we'll talk a little bit more about that as well um what is managed Medicaid this was one of the questions that um I think Nancy had sent over how this might impact managed Medicaid um how is that different from traditional Medicaid so
• 19:00 - 19:30 often State Medicaid agencies which are that administrative Branch um that is in charge of administering this benefit for folks in their state um they contract with Managed Care organizations to deliver services to those covered lives those Medicaid beneficiaries that are enrolled in their State's Medicaid Program mcos or medic uh Managed Care organizations are more akin to a private health insurance plan because they set their own rates they have separate rules although they do have to typically
• 19:30 - 20:00 follow the general rules established by the State Medicaid Program with some exceptions for example with the state um like a fee schedule that is set by the State Medicaid Program oftentimes managed care companies will pay providers less than what is on that fee schedule sometimes it's a little bit more sometimes it's the same amount so I give that as an example of a way that they are slightly different than a typical feif for service Medicaid Program Medicaid is very different from Medicare I know sah talked a little bit about already how different um Medicare
• 20:00 - 20:30 is but typically we will hear from our members through our technical assistance questions like hey you know Medicare is doing X why isn't Medicaid following it part of that is the design of the program is supposed to allow states to design the benefits that cover their beneficiaries in the best way for them um Medicare is largely run at the federal level by CMS the centers for Medicare and Medicaid services um with funding appropriated by Congress Medicaid is slightly different in that
• 20:30 - 21:00 you want in that states will run that program and design it at the state level for themselves um we have a new resource that compares the Medicare and Medicaid Program it's a booklet that I think is very user friendly I'd be happy to share that a little bit later um but it it explains the differences and even more granularity I don't want to spend too much time on that because I want to make sure we get to all the proposed changes that may be coming to the Medicaid Program but some of those policies that I think to speak to s's um point about tella Health while Medicare may be doing
• 21:00 - 21:30 something different um as it pertains to Medicare coverage of tah Health Services St Medicaid programs can also do something different however I have good examples of how oftentimes Medicaid programs do follow medicare's lead for example South Carolina Medicaid within the last year was considering eliminating telea health for Therapy Services thankfully um myself and our state Association leadership were able to convince them of the value of teleah health services um provided by speech
• 21:30 - 22:00 language Pathologists um and so they changed their mind but they were doing that because Medicare was not covering tah Health on a permanent basis so that's an example of how Medicare policy can sometimes influence State Medicaid policy um changes to Medicaid funding though also impact Medicare beneficiaries one in five Medicare beneficiaries is also dually enrolled in the Medicaid Program Medicaid helps Medicare beneficiaries often pay for things like premiums and other wraparound care that is not necessarily covered by traditional Medicare um so
• 22:00 - 22:30 the thing to know about Medicaid because it is that joint federal and state partnership is in order to actually Advocate and move the needle on the priorities that you may have like preserving telea health or increasing reimbursement rates you have to Advocate at both the state and the federal level next slide please so we're going to talk quickly about the budget reconciliation process and I'm not going to get too weedy because then my eyes tend to glaze over and this is where I get you know with
• 22:30 - 23:00 our federal lobbyist they know the Nuance of this so well but I do want to just kind of give a how did we get here kind of of setup So currently our Congressional um members of Congress are engaging in the budget reconciliation process so both houses are putting together different versions of a budget that they have to come together and reconcile um it's an optional Congressional process that operates as um slightly different from the typ iCal budget resolution process part of the
• 23:00 - 23:30 benefit to reconciliation is there's no filibustering allowed on the Senate side so this is a way to expedite the process and is truly to Sarah's Point earlier about how the administration is putting forth its priorities very quickly this is a a clear directive from the president's office to kind of get a budget um from the from Congress quickly and to establish um what the priorities are for this Administration going forward um reconciliation inst instuctions are those means by which
• 23:30 - 24:00 Congress Congress establishes the roles that each committee will play on both sides of both the house and the Senate house and the Senate excuse me will be um trying to work together to achieve those budgetary goals next slide please so you may have heard and seen in the news that there was a house budget resolution that passed it was a very tight vote um 217 to 215 which um is kind kind of a trend uh in the past you
• 24:00 - 24:30 know I'd say 20 20 so years of how um extremely divided both our country and our um elected representatives are that they the house um on the sort of you know there's the house and the Senate the house Advanced their version of the budget resolution that outlines significant spending reductions to allow for those proposed tax breaks that President Trump has promised as I mentioned earlier um these are contentious because we are effectively in this specific situation using
• 24:30 - 25:00 Medicaid as a way to pay for a lot of those promised cuts and I'll address a little bit later some of the questions folks have asked about well you know president Trump has said that he's not going to touch Medicaid and you know I've heard from my elected representatives that they're not going to cut Medicaid um through the process of elimination there are not many places that these elected folks can really look to to pay for these proposed tax cuts without dipping into those funds there's a great um paper that um the Congressional
• 25:00 - 25:30 budget office just put out at the request of several Democratic senators and what they did was they said hey you know is there a way to pay for these Cuts without going into Medicaid and the answer was effectively no I'd be happy to share that with you a little bit later um I don't have that one on my fingertips but I think it'll be very helpful to kind of illustrate that point so right now we're looking at $880 billion that must be cut on the house side the Energy and Commerce Committee on the house side is coming together and they are um designing a program that
• 25:30 - 26:00 will help put together you know and decide which programs will be cut in order to pay for those proposed uh tax cuts and a number of other um projects that President Trump has put forward in his agenda um not only will it probably affect Medicaid um and the Affordable Care Act but there's been discussion about whether food assistance programs will be affected as well this is separate from the federal funding freeze that you may have heard about in the news this is a completely separate issue
• 26:00 - 26:30 so that is the house plan the Senate is also working on their own version of a plan they have to come together as I described earlier and decide what their final uh plan will look like in order for this to be approved by both houses and then be put into effect it will be over a 9 to 10 year period where these costs um or these changes will be put into effect um next slide please Sarah so why is medic risk I started talking a little bit about this but um
• 26:30 - 27:00 as I said the Energy and Commerce Committee on the house side has to find because of that budget resolution $880 billion do in savings they only have a limited set of programs that are within their jurisdiction that they can take that money from um since Medicare is off the table um then they've said that multiple times they've said that about social security and a number of other programs that they won't be touching those programs and Medicaid has also been said not to be touched but they will improve it or enhance it or make it
• 27:00 - 27:30 better um it's more likely that the funding Cuts will come to Medicaid than those other programs um this is often because there is a misunderstanding about what Medicaid is who it helps and how it works um that's not a political statement that's a that's not conjecture that that is um a sentiment that I've heard directly from members of Congress and their staff um and I'll talk a little bit about what Asha has done recently but I've been personally meeting with members of Congress staff
• 27:30 - 28:00 people and kind of explaining to them you know these are the people that are served by Medicaid these are the providers that serve those people these are the critical services that they provide um and I've had to explain some very uh basic elements of the Medicaid Program because a lot of the time there's a perception that Medicaid is um lowincome only low-income folks or folks that aren't working um but it really is such a robust program that serves so many people across the lifespan there's a lot of misunderstandings about it um the other thing to note is that Medicare
• 28:00 - 28:30 typically involves older adults who are a very vocal voting population um Medicaid does not have the same in the past Medicaid has not had the same voting um strength that Medicare has had so you will see that it's much easier for congress people to put forward plans to cut Medicaid politically than it is to cut Medicare next slide please so here are some ways that Medicaid
• 28:30 - 29:00 could be changed going forward now um I will describe some of these plans or these suggested methods however you may have seen in the news that again some you've heard oh we're not going to touch the fmap oh we're not going to move to per capita cap so I'm I'm explaining what these all are these are absolutely not all going to happen these are just different ways that they may choose to flesh out that budget resolution that they have to do in order to make those cuts they've promised so lowering the
• 29:00 - 29:30 fmap as I talked about earlier that's that Federal Medical Assistance percentage that would lower the amount of money that the federal government would contribute to the state so they could drop it you know below that 50% floor that it is currently right now that would be very difficult for states to um what we're hearing from States and what you've probably experienced in your States is many states are already experiencing a budget shortfall I know Indiana is one of those States that's already in a very critical time for that um and what's going to happen is without
• 29:30 - 30:00 that Federal those federal dollars matching States will have to make up the the uh costs that they will no longer be getting from the federal government that was is going to be very difficult and even the best of years um many states are actually in their legislative session right now as you all are active advocates in your state you already know that um I think the the trick is that states are designing their budgets in some states as if they're going to continue to get the same amount of money from the federal government that they
• 30:00 - 30:30 have been getting for years through that Federal matching or medical assistance percentage so some states are already starting to pre- comply some are anticipating these Federal cuts and building in Cuts in different ways that will that will affect Health Care delivery services so that's lowering the fnap one particular way we've heard from speaker Johnson that that methodology is off the table um I think it's important to note that when members of Congress are facing with difficult decisions sometimes the plans change so some it is
• 30:30 - 31:00 good to know what this means even if at this moment it has been promised that it is not on the table um per capita caps are similar um they are a set amount of federal funding per Medicaid enrolled beneficiary so if you have 20 million people I'm making that number up in a given state that are enrolled in Medicaid they would get let's just say $100,000 per Medicaid beneficiary for a year and again in those situations when when states don't have that additional
• 31:00 - 31:30 Federal funding that really depends on how much they spend per beneficiary in each state um you're going to have situations where States will have to make up that coverage difference that's going to be very difficult for you think of very medically complex kids adults kind of the whole lifespan you may also think of folks who may be newly disabled that are enrolling in Medicaid and not able to really anticipate the amount of cost that they're going to um going to incur so this would also be very difficult for states to absorb the cost
• 31:30 - 32:00 from block grants um there is a set amount of federal funding per state so um California would get the same amount of money as Vermont as you know Rhode Island and that would be very difficult again for the same reasons I've articulated if states were given a set amount of money we've seen variations of this play out in other states um and in for example in um Puerto Rico they played out ail lot Grant scenario um
• 32:00 - 32:30 Puerto Rico has unfortunately been uh a victim of this kind of financial situation and I'll share why because it's been so difficult to manage the amount of folks enrolled in Medicaid and anticipate those costs and they've had to have several infusions of money from Congress to make up for the budget shortfalls that they've had it's been it's been much more difficult for them to navigate um and they were in the process of exploring going back to the fmap because of that situation another way that Medicaid could be
• 32:30 - 33:00 changed would be through work requirements this is probably the most attractive option on both sides of the aisle um there's a sentiment in America that we should have to um pay for our health care um and that we should have to work for our health care all of the principles aside that are associated with that work requirements are very expensive to administer a work requirement um would be something where you have to prove that you are either working full-time working part-time or that you are a person with a disability
• 33:00 - 33:30 so You' get an exemption you're caring for a person with a disability as a family member or you're in school um so those are those are some of the ways that work work requirements work the difficulty in administering them is that it takes a lot of program staff time it takes additional um you think like web resources that sort of thing to administer that additional layer of administrative burden um in Georgia we have good data that shows Georgia's pathways program has been very difficult for the state agency to administer
• 33:30 - 34:00 initially it was suggested that it was going to cost around $2,000 per enrol Le it actually costs around $113,000 per enrol so a very large difference um it's also taking a lot of Staff time from the agency because they're instead of working on additional coverage for folks that are enrolled and just administering the regular benefits they are instead working on making sure that they're reporting their employment and a lot of times I will be um I will
• 34:00 - 34:30 hear from people like oh well isn't it like EMP unemployment or you just have to like click a button and verify like oh I'm looking for a job or I'm continuing to look for a job and then you get your benefits it's not at all like that um at least in the Georgia Pathways program Arkansas also put in a work requirements program in 2018 that resulted in 177,000 people losing coverage within six months um so lots of big changes and um and and even again politics aside about work requirements it's just a very administratively
• 34:30 - 35:00 burdensome and expensive program to administer another way that Medicaid could be changed is as I alluded to earlier eliminating Medicaid expansion population so eliminating coverage um as part of you know what was originally created by the Affordable Care Act or Obamacare as it's commonly known um for those low-income adults who are not necessarily poor enough to be under 100% of the federal poverty line they go up to 133% um one members of member of congress's staff was asking for specific
• 35:00 - 35:30 data as to how many people fall into that category in their particular State we heard it from another member of Congress that they wanted a state-by-state breakdown of that number um and I will share with you we've been meeting particularly with Republican offices because they are the party that is in control of the house and the Senate um and that has been a very popular option and and they continue to explore that now even in your non-expansion States I think of Florida um Geor has this non-traditional expansion Texas um you know there will
• 35:30 - 36:00 still be uh hits to your State Medicaid Program should there be some kind of lowered um either fmap or changes to the Medicaid Program even if you don't have that expansion population because I've also heard from folks well I my state didn't expand so I'm not worried about that well anytime you have less money coming into your state or them changing the benefits there will be Downstream effects for your state as well um eliminating coverage for undocumented
• 36:00 - 36:30 individuals uh as it is right now it is fairly difficult for an undocumented individual to attain Medicaid beneficiary Medicaid benefits some states have expanded in some ways to include some of those as you've probably seen uh dreamers or DACA recipients um as part of their Medicaid Program um eliminating coverage for them would probably not net the amount of savings that uh they need to create that $880 billion it probably wouldn't even be um a drop in the bucket for that
• 36:30 - 37:00 overall picture that they need to continue to to work on solving and then eliminating St state taxes on providers so as you all probably know as medic many of you are Medicaid enrolled folks and Medicaid enrolled providers I should say States currently tax providers um and how that affects uh the state fmap that Federal matching percentage um is that when providers pay that tax that shows as a an expend for the state once they're paying out those higher provider reimbursement
• 37:00 - 37:30 rates now this is an important source of funding for many states in order for them to pay that that state side of the Medicaid um overall pot of money so you have your federal dollars that are contributed in your State dollars provider taxes are part of those State dollars if those were eliminated those would be very difficult for states to make up and be able to continue to pay for services for for all of the folks that are enrolled in Medicaid next slide
• 37:30 - 38:00 please thank you um so no problem so um so I won't go through all these we kind of talked a little bit about this on the last slide but I did want to just give you an idea of what how much money um we're talking about when we're talking about each of these different options so imposing those per capita caps would save 900 900 billion and I should say that 880
• 38:00 - 38:30 billion is a floor they can save more and cut other things or they can stick to the $880 billion do so um eliminating those state taxes on providers and you can see I'll be I'm happy to share these slides after the um presentation too I'll be sure to share those with you Nancy to um distribute to your members um next slide please so again want to talk a little bit about the rhetoric versus the reality um you know often times as I
• 38:30 - 39:00 shared earlier we will hear that for work requirements especially you know requiring able-bodied adults without dependence to beat certain work requirements as a condition for Medicaid coverage would restore the Dignity of work and prevent Medicaid from serving as Ware this is a very common talking point that we've heard in our um meetings with members of Congress and their staff not only does it increase you know um the administrative burden and has lots of administrative hurdles it's very difficult to implement in a rural state or in a state with lots of seasonal work sometimes shift work can
• 39:00 - 39:30 be difficult so you could really be at the um you know oftentimes shift workers will say oh I don't know what my hours will be in a given week so I don't know whether I'm going to satisfy the work requirement so I might actually lose my health care even though I am working the other thing we think about is people with disabilities seeking an exemption to those work requirements they're very difficult in practice to get um there's a great paper I'd be happy to share from the national health law program that breaks takes down every point at which Georgia's Pathways program with this
• 39:30 - 40:00 work requirements sort of um requirement built in um makes it difficult for people with disabilities to opt out and to show that they are exempt from the program um per capita caps as I shared earlier it's it's going to be very dramatically difficult for states to be able to make up that difference in costs um they'll have to explore innovative ways to reduce costs and we'll get into a little bit more of that on the next couple of slides but they are likely going to have to limit benefits and
• 40:00 - 40:30 constraining enrollment in creative ways in order to make sure that they don't exceed the amount of money that they are able to spend on this Medicaid Program same thing with flot grants they do give States more uh flexibility because they can say okay here's your set of money do with it as you will um and do your best to cover as many people as you can including those mandatory populations that we have to cover and we'll talk a little bit more about that on the next slide but those big cuts are are going to mean um Draconian Cuts uh to services
• 40:30 - 41:00 and enrolled folks as well next slide please so reiterating again the house Energy and Commerce Committee and Senate um the senate committee assigned to this particular situation have a difficult job um I've heard from many members I've heard that you know Medicaid's not really going to be cut and they're just eliminating waste Fraud and Abuse is that true um while every system can improve and I would wager that there is
• 41:00 - 41:30 fraud and waste and abuse in every program private insurance Medicare you know all of these things there's simply not $880 billion dollar in waste Fraud and Abuse to cut that's just not fiscally possible um you're going to have to cut into um optional populations and uh additional services that are covered above and beyond what's legally required which we will talk about so those programmatic changes like work requirements that aren't really um that people say oh well that's not a cut it's just an administra of change they do amount to per se Cuts in the end because
• 41:30 - 42:00 of the way they are administered and how much they cost next slide please so I want to talk a little bit about um how this could impact providers in health care settings I've seen some you know questions in the chat well like how would this apply to me or what what does this mean for me so coverage of therapies will not be eliminated under Medicaid because of the early in periodic screening diagnosis and treatment law this law was came out as part of the Social Security amendments act and it requires all Medicaid
• 42:00 - 42:30 enrolled children under age 18 or 21 depending on what state you're in to be covered by Medicaid they have to be medically necessary so speech otpt Audiology will still be covered for those populations however there are many implications for those services that are not required to be covered under epsdt um there are things that you think about so like in a state that has an fmap let's just say per let's say they changed the fmap to 50% um that would
• 42:30 - 43:00 decrease the amount of funding you would see you could see provider rate decreases we know um I know Sarah and I hear from our members every single day provider rates are dismal for most Medicaid programs I have yet to get an email that says you know what my Medicaid Program is Rock valid and I don't need any help that has not come across my desk yet um but one day I hopeful that we will improve the the Medicaid Program to do so so the way that will happen is because programs
• 43:00 - 43:30 will have to cut they will have to say you know what I have to cover these mandatory kiddos kiddos will still get services but in order to continue to offer those services to kids I'm going to cut down provider rates um that would be one creative way that and even sources like Politico and other um and other uh news reports have already cited States exploring those options as they continue to have um you know these conversations you'll also see patient case load changes so one of the first
• 43:30 - 44:00 things we always recommend to our members is having a diverse case load wherever possible try not to rely on one single source of um Insurance funding BEC and and we realize that's difficult some areas are you know profuse with Medicaid populations that's really the only game in town sometimes it's a really small Medicaid population but Medicare is the big player it really just depends on where where you are um so if you see a situation where adults are no longer um you enrolled in Medicaid that would obviously affect your case load if you're seeing adults
• 44:00 - 44:30 you're going to be able to see fewer people the same would be true for kids enrolled in Medicaid if their parents for example are subject to a work requirement and their parents do not satisfy the work requirement there could be changes in enrollment to their family such that they may also lose coverage we saw this through the Medicaid redeterminations process when different members of families in in the same household would lose coverage as the state was determining eligibility for the program after covid-19 ended so I I
• 44:30 - 45:00 would anticipate that there could be changes to who's enrolled they might lose coverage they may churn that sort of thing optional Services May no longer be covered so Home and Community Bas services like OT PT and speech I'll provide um are optional under Medicaid so Medicaid has what's called the institutional bias and that means that the only services that are covered that are required to be covered are in hospitals in um the in sort of like
• 45:00 - 45:30 those institutions I hate that word it sounds so like old school but that's just the nature of what that bias is so those Home and Community Based Services you think of Home Health um you think of potentially changes to the Early Intervention programs in different states because of that reduced funding those are optional Services um when they're delivered outside of the institutional settings now what states typically do is they have what's called a Medicaid waiver and some of you may be familiar with that states will cover optional Services through a Medicaid
• 45:30 - 46:00 waiver if a state is in a situation where they have a extremely decreased Financial Outlook and they don't have as much money coming in from the federal government they will absolutely be covering as many or cutting I should say optional Services as one of their sort of basket of options that they can do to be able to fiscally continue unlike the federal government state governments cannot continue to operate at a deficit for years and years and years that's just not how their budgets are designed so the other thing to think about and
• 46:00 - 46:30 many of you have probably heard of Katie Becket waivers um the tax equity and fiscal responsibility Act of 1982 was created because of Katie Beckett who was a child who had contracted viral in sephtis when she was 5 months old she was in a hospital bed for the rest of her life or in a bed I should say confined to that bed um and her mom wanted her to be seen and be able to stay in their community so she approached Congress she approached approached President Reagan and said I need to have my child be able to be seen
• 46:30 - 47:00 in her home setting instead of being stuck in a hospital they created that law which made it optional for states to be able to cover Home and Community Based Services and for folks to be able to get those Services through a Katy Becket waiver um currently there are I think around 43 states that have those K backet waivers so Most states have them and what it does is it covers services for kiddos with disabilities under the age of 19 so that they can stay in their home instead of being in an institution
• 47:00 - 47:30 those again are optional Services um so if a state is in a dire financial situation um it's going to be difficult for them to continue to cover those optional Services low-income adults as we've talked about in states with trigger laws um there are nine states that have those and if that Federal funding drops below a certain rate they automatically cut out um certain populations like adults things like that also teleah health coverage um that's all optional uh State many State
• 47:30 - 48:00 Medicaid programs I'd say most at this point have opted to cover teleah Health um but uh in a situation where they have to make up funds is that one area I could see them cutting definitely um so again not trying to sort of you know freak anyone out it's just one of those things where it's good to know all of the different things that are possible and part of the basket of options that states have as they are in this changing fiscal environment um the other thing I could see happening is increase utilization management techniques um prior authorization would be a great way
• 48:00 - 48:30 to constrain Services um I could also see pre and post-payment review I don't know if you have anyone on the um line from Vermont they recently eliminated prior authorization for Vermont's Medicaid recipients of speech otm PT which is great however we're now seeing an uptick in post pre and postp payment reviews so before they're getting paid even though they don't have to go through the prior authorization process they are still having that increased look at um how their services are being
• 48:30 - 49:00 delivered and whether or not there's any kind of audits that might be performed in the future and same for audits that would be a clear way that states could come back and say you know we need to really re in our spending let's take a closer look at a lot of the things that providers are doing next slide please so how could this affect providers in school settings um I'm sure many of you kind of work in both settings or have kind of like wear lots of different hats we hear from our
• 49:00 - 49:30 members that kind of works lots of settings so Medicaid is the fourth largest funding stream for school districts there are 25 States currently who build Medicaid for the services that you all perform um Medicaid permits payments to schools for services provided under idea or through um through an IEP or an ifsp you all are familiar with this so I'm not going to belver the point on some of that but if you have questions for me you can always reach me at reimbursement Asom .org I'll be sure to include that in the chat as well so the reimbursement that schools
• 49:30 - 50:00 receive for those direct Medical Services like speech OT and PT to those Medicaid enrolled students are often used to support or fund the Staffing of those professionals so the Medicaid dollars coming in for the services provided pay the salaries of the folks who are delivering it this is often the case or to pay for specialized equipment like AAC sgds all of those 68% of districts do that so without sufficient Federal Medicaid funding schools who build Medicaid will be forced to make
• 50:00 - 50:30 tough choices about the services they provide and the health professionals that they employ um I could you know we we know as a country that the Ida law has never been fully funded we've never had a situation where we've had enough money to provide all of the special education services I like to say that Medicaid in some ways is a Band-Aid over a a bullet wound because they just don't have enough money to be able to provide those services but it was sort of like let's try and fix it where we can so without that money you're going to have a bigger problem in order to provide
• 50:30 - 51:00 those services and even if your school doesn't build Medicaid say you're in one of those other 25 States the students who are enrolled in Medicaid in your school will still have um potentially more difficult access to care they might not be able to see people in the outpatient setting they might have to wait on long wait lists in order to get Services um there are still going to be Downstream effects even if your school doesn't build Medicaid next slide please so what has Asha done um now that I've catastrophized at you for 50 minutes um
• 51:00 - 51:30 i' I'd love to share with with you a little bit about our advocacy and how things have have the conversations we've engaging in so we developed a take action campaign and um and I'd be happy to link to that too it creates a letter that goes to your elected representatives that says hey don't cut Medicaid don't take away these vital and crucial support services that we provide um we had over 10,000 messages sent in three weeks we're up to about 13,000 at this point or right around 13,000 um and
• 51:30 - 52:00 those are directly to your letter to your members of Congress we've been participating in those direct meetings with members of Congress through our um through our leadership in the Consortium for constituents with disabilities um and then also the modern Medicaid Alliance those are two big coalitions we're a part of and then we've also had members of ashta join us on those members uh in those meetings with members of Congress to provide sort of Provider perspective because one of the things that we've been emphasizing to our members is that our members of Congress you know they hear from lobbyists all the time you know they
• 52:00 - 52:30 hear from us saying hey don't touch Medicaid but what they really care about is hearing from you all you guys are the people that are their direct constituents and frankly you pay their bills so they need to listen to you so it's always important to reach out to them to know that your um your provider needs are being heard and met um we also took it took an opportunity to share stories um with the Senate finance committee that Chuck Schumer and others used and floor statements to help protect and preserve Medicaid sharing
• 52:30 - 53:00 you know um patient stories things that folks have gone through and heard and dealt with as they've administered the program benefits that Medicaid is is unfortunately probably going to cut or will be cut for Medicaid um we've sent letters to Congress ourselves we've we've worked on this like as an organization Asha among many other stakeholders and then we've also been meeting with we've leveraged asha's political action com uh Camp committee excuse me um in order to meet with members of Congress during fundraisers and and emphasized our agenda protecting
• 53:00 - 53:30 Medicaid next slide please and then what can Asha members or folks on this call do to help as I said you can take action to preent protect Medicaid now um I will be happy to share with you all a link if oh I see Lauren put that in thank you Lauren for flagging that you can go there click it you don't have to be an ash member I had my husband do it I had my neighbor do it um it's really important that we're all sending in members uh letters to members Congress to let them know what our priorities are um if you get a form
• 53:30 - 54:00 message back that says hey I'm not worried I'm not cutting Medicaid like feel free to reply to them and say no but but I would love to hear your plan and what will you support and what are your priorities if cutting Medicaid is not part of that you can also attend a town hall or schedule a meeting with your federal representatives in their state and District fun fact next week is a congressional resource so every member of Congress will be back in their own District consider reaching out to them or even just stopping by and saying hey can I meet with you to talk about these
• 54:00 - 54:30 things that are really important to me as a provider and a taxpayer in your District um and then uh contribute to ashop Pac that was focused on our members again that's a way that we interact with members of Congress wherever possible next slide I think that takes us to our questions so I did put reimbursement at asha.org there you can always reach out to that um if you have questions um so I I can take a crack at kind of answering some of the questions that are in the chat Nancy I know we have five minutes and I want to
• 54:30 - 55:00 be respectful of everyone's time sure I just want to say one thing please well first of all thank you so much we'll get to the questions guys there's a three question surve so that I can bring you more data to help you with this and this is not my wheelhouse as you know I need you all to take the time to answer a three question survey so I can formulate adoptive uh solutions to what we obviously are
• 55:00 - 55:30 all dazed and confused about what to expect so with that please um uh I don't know what the best way to do the questions is I guess if you raise your hand and um do you know how to do the hand raise the hand raisy thing you must have questions nobody has a question did you want to well there's uh I don't see any I would love to answer one if that's okay just because I do
• 55:30 - 56:00 Absolut please take it away so um MDA um I'm sorry if I'm pronouncing your name wrong um but I think I just want to clarify something so outpatient otpt and speech could be optional going forward so what that looks like is those Services would be considered Home and Community Based Services Medicaid Program many cover those Services now in a situation where their budget is Extreme constrained States will have to make choices about what they're going to
• 56:00 - 56:30 cut and what they're going to continue to cover cutting Home and Community Based Services is one of those options available to them that doesn't mean they're definitely going to take it but it's just one of the things that they could do hopefully that clarifies um that point I can't find where to raise my head my hand but I see the same question coming up over and over again in the chat which is uh let's see let's go back
• 56:30 - 57:00 here now all of the questions are coming in can we limit our Medicaid case loads and charge families for services not covered by Medicaid so a couple people were asking if it's legal to cap their Medicaid case load at a certain percentage yes that is absolutely Ely true um there's no also ethical at least for Asha members I can't speak to ethics
• 57:00 - 57:30 code for other organizations but there's no ethical um problem with doing that it's important to diversify your case load to support the practice that you have in your area so there's no reason that you have to take every Medicaid patient who walks through your door and in fact we don't necessarily think that's a good idea for most especially small business owners just based on the Medicaid rates where they are and can I add to that sorry for cutting in but I diversify my case load
• 57:30 - 58:00 by taking School contracts and early intervention cont contracts but they could be affected too so really my efforts at just diversification have not safe proofed me from these Cuts understandable that's absolutely true and I think you know Sarah talked a little bit about budget neutrality earlier and how you know medicare's decisions or medicare's lack of a funding I should say Sarah um has trickled down to other payers for
• 58:00 - 58:30 example um we are aware of a payer in Pennsylvania that as a direct result of medicare's cut said oh we're going to reduce payments and and Sarah can well tell you that they don't have to reduce payments it just because Medicare is cutting rates but it's convenient to them to point to an alternative source as a source of authority saying oh well they've clearly said that these Services aren't as value valuable when that's not at all the case it's it's a budget neutrality principle so you all are in very difficult positions Lauren I
• 58:30 - 59:00 totally hear what you're saying that even diversifying is not always insulating you from some of those um issues but I do think that that is at least one of the steps folks can hopefully take if they have a large Medicaid population now so there's not a hand raise option there are questions coming in like from Pam Marshall can you explain how Asha aota and APTA have worked together I think we are better in numbers working together and getting parents involved I've been working with Caroline in Idaho for Idaho Medicaid and
• 59:00 - 59:30 reaching out to aota and APTA members to find out key stakeholders to work with us but I'm not sure on the national stage so Sarah and I both work with apaa and aota I also work with the state Affiliates for those organizations for example in Pennsylvania where um 9257 which is your bread and butter speech code gets you around $21 I don't know if you have any um folks on the call but it's among the lowest in the nation so we've been working together as a tri
• 59:30 - 60:00 Alliance to work on rates there we've done a survey um of our providers in the state we're actually setting up a meeting with the Medicaid agency within the next couple of weeks and hoping for some kind of change to the Medicaid rates because they are limiting access to care in that state that's one example just I mean we have many I just I know we're at two o'clock also I put together an advocacy panel on the upcoming spring event and
• 60:00 - 60:30 it's basically consists of people just like yourselves owners that are fighting on the state level so we have people that are really doing a lot of the work for like one or two people that are doing a lot of the work for one state we could really use coming together and that's why I put spring there because I kind of saw this coming so I put this advocacy panel together I don't know Carolina and sarif we could talk later maybe there's somebody um you know
• 60:30 - 61:00 there'll be well over 100 150 owners um and we've got to get boots on the ground because there's such a disconnect from understanding and announcing that autism is for instance is one out of 30 cases when it used to be one in 2000 and they were going to make all these cuts it it's there's a disconnect and I just feel like if we can get it in front of the right people but that's going take all of us coming coming together and I will say the other thing to do I hear a lot of fear in the
• 61:00 - 61:30 questions understandably the thing to do guys is not to contract do not contract of course be fiscally responsible etc etc but try not to go into fear and always try to take action action is the antidote to everything there's going to be a lot of strategizing on how you can diversify how you can there are solutions we've been helping people for 30 36 years we've seen it all especially in the adult PT field where it almost wiped out
• 61:30 - 62:00 that whole profession we helped a lot of people get through so something can always be done is what I want to say and if you can get to Spring and not contract and not be like I don't have the money for this we're gonna band together we're going to Round Table and there's a ton of people that have been legislating and advocating and like I said Caroline and Sarah if we could get any help on that even if it's through a zoom call that that would be phenomenal
• 62:00 - 62:30 um we do have a high amount of speech paths that attend um sprinkling of OTS and I mean of uh audiologists anyway is there anything else last question or two before people jump off um one thing I did want to flag just because people are talking about getting parents involved and getting other folks anyone could do to take action so can be parents you can send it to your clients have them send a message anyone can reach out to their Congressional Representatives on by phone additionally next week we're going
• 62:30 - 63:00 to um have a a day of action on Medicaid on Ash's social where people can call the offices there'll be a option to just click a button through the social media page and it'll bring it up really easily for you all we're also at this point exploring Gathering patient stories from providers in order to more effectively streamline and send them to different I'll just be honest Democratic offices who are looking to use them to um safeguard the program hopefully that helps and and truly appreciate all of your time and thank you for letting me
• 63:00 - 63:30 talk at you for an hour and if you have questions reach out to reimbursement asha.org as well that that's phenomenal Caroline Sarah cannot thank you enough um all of you that attended uh we will get the slides to you and we will get the uh any links that Caroline and Sarah can provide we'll we'll get that to you so just look in your email and look for announcements in the Facebook group um so that that's all I want to say is thank you so much I know it's kind of a
• 63:30 - 64:00 dicey time but hang in there we will get through I we we got through covid that's all I can say is we got through a pandemic so um ladies thank you so very much and um thank you for having us on also oh my my pleasure my pleasure thank you so much yes can we ask one more question I don't think that line said when we expect these changes to happen
• 64:00 - 64:30 timeline wise so the cuts will be over the next 9 to 10 years that 880 billion is what it's going to be sort of cut across but as I said some states are already sort of pre- complying even some Hospital systems are pre-comp and saying oh we're going to cut these services or we're going to redesign our state budget um an anticipation of lowered feder Federal funding so every State's kind of handling a little bit different uh but yet the cuts will be over that eight that 9 to 10 year period hopefully that
• 64:30 - 65:00 helps could you maybe go over the dates like I wrote down March 14 15 and 31 maybe quickly I think that was in the tah health section yeah Caroline if you need to jump um I do I'm just going to meet with Florida Medicaid now so I I appreciate it very much and I so much okay thank you so the deadlines that I talked about so at this point Medicare Medicare nothing to do with Medicaid
• 65:00 - 65:30 tella health will end on March 31st unless Congress passes a law that will continue to allow non-physicians like audiologists slps pts and OTS um to can to get covered for their services under Medicare so we need something to happen from Congress before March 31st given the congression calendar the most likely legislative vehicle to do that is the next
• 65:30 - 66:00 government funding bill which has to be voted on by this Friday March 14th so there could be additional vehicles that happen after March 31st but at this point the only legislative vehicle we have to address the March 31st Cliff is going to be voted on this Friday March 14th so we'll no more Friday late late late Friday first thing Saturday
• 66:00 - 66:30 morning okay great thank you anybody else last minute questions going once going twice thank you thank you for the opportunity oh our pleasure thank you so much can't believe we pulled this together from like Friday night and we had like almost 400 registrants so there you go guys take two minutes to fill out the uh thing and if you have any the survey and if you have any questions I'm available at hello pizzapalooza
• 66:30 - 67:00 outcom um if you can't find something or you have questions about advocacy in the group please by all means reach out looks like you guys are checking out so just want to say thanks again your time is so valuable for us thank you thanks thank you so much Sarah [Music]