Synopsis of the Issues in HP Session on Medicare, SSA, and LAcs (April 2021)
Megan Gale
An Issues in Hospital-based Practice Webinar Series special session
Event held live through zoom on 4.14.2021
All notes, pdfs, and recordings are accessible in the Issues in Hospital-based Practice webinar series module. Only some of the event information is shared below.
title slide for the Issues in HP session held April 2021.
The Hospital Handbook Project (HHP) hosted this live virtual event on the evening of Wednesday, April 14th, 2014, from 1800 – 2000.
Thank you to our guest speaker, Dr. Kallie Byrd Guimond, O M.D, MPH, federal lobbyist, Sustainable Influence, LLC.
The special event, hosted by The Hospital Handbook Project on the evening of Wednesday, April 14th, 2021, focused on the how & why of Medicare, the Social Security Act, and federal legislation as it is related to licensed acupuncturists.
Event Audience
The intended audience for this event was hospital and healthcare system-based licensed acupuncturists and their program managers/hospital admin. Registrants represented the following types of healthcare system practice: FQHCs, hospice, academic medical centers, rural hospitals, hospitals in metropolitan areas, safety-net hospitals, federal treatment facilities (VHA and DoD), and pediatric/Children’s hospitals.
We had over 50 registrations for this event and about 45 actual attendees.
Updates since this April 2021 session
Rep. Judy Chu (CA) introduced the new bill in July 2021. In August 2021, I created a new blog post with more information and room for updates on the HHP website here: https://www.thehospitalhandbook.com/blog/2021/8/14/medicare-update-hr-4803-acupuncture-for-seniors-act
Updated information about the November 2021 Atlantic Symposium and the AcuCongress virtual training(s): https://www.thehospitalhandbook.com/events/2021/10/3/atlantic-symposium-guest-speaker
Megan’s introduction presentation is about 14 minutes
Please see “Megan’s intro slides” pdf for full details
Synopsis of content with timestamps:
Minute 0 – 6 Introduction
Link for the HHP’s origin story and vision for the work, “Introducing the Hospital Handbook Project”, February 2021 presentation.
Minute 3+
How the HHP defines the term “hospital and healthcare system-based practice”
Minute 6 ½ - 10 ½: Why Today’s Session?
Includes background of the issue, HHP community discussion work, refining the questions and issues, and the need for the HHP community to hear and learn from someone who is an expert in federal legislation as related to the fields of integrative health.
Medicare coverage decision on acupuncture for cLBP in June 2020.
When you can refine your question(s), it is easier to understand the issues and find or develop solutions together.
Minute 10 ½ - 11
Common themes in questions submitted during registration for this session
Minute 12-13
This session does not cover the Medicare billing process
Minute 14:20
Introducing our guest speaker.
Guest speaker Kallie’s presentation was about 45 minutes
“Medicare Inclusion of Licensed Acupuncturists”
Dr. Kallie Byrd Guimond, OM.D, MPH
Short synopsis of guest’s presentation
Our guest speaker, Dr. Kallie Byrd Guimond, OM.D., MPH, reviewed the history of the Social Security Act (SSA), the federal legislative process, and past and current efforts on federal inclusion language legislation for LAcs.
title slide for Kallie’s presentation begins at about minute 15 of the recording
For a review of all her slides, see the “Kallie’s slides” pdf in the Issues in HP module
I’ll add a synopsis of the webinar session in the blog below, but the formatting is better in the pdf. I recommend downloading the complete notes available for a much-discounted purchase below. The endnotes and references work better in the pdf “Notes” than in this blog post. Also, the pdf “Notes” has more information than this blog post.
Minute 15: What the Social Security Act is
Passed in 1935
Created the Public Health Service
Eventually created Medicare
More history of the SSA in the endnote reference [i])
Minute 25: Why be part of the system?
What are the benefits of a unique profession being recognized as a provider by the SSA, and therefore CMS?
Patient access to your services
Federal student loan forgiveness programs
Develop & implement hospital-based residency programs
CMS funds ~95% of residency programs
Some related references for more in-depth reading may be the following endnote[i]
Minute 32-33 Kallie mentions the CMS Handbook,
The CMS Handbook, “Medicare and You 2021” page 1 and page 30 states that acupuncture is covered.
The ambiguity of how Medicare contractors are interpreting this
Minute 33 Kallie mentioned HRSA grant
Kallie’s example of policy efficacy from a hospital-level perspective
HRSA’s grant for COVID hospital treatment of uninsured patients, part of the new CARES Relief Act bill
Minute 35: It Takes an Act of Congress slide
Introduces Rep. Judy Chu (CA)’s video https://youtu.be/fSvqsykBrXY
Webpage for Rep. Judy Chu (CA): https://chu.house.gov/
Minute 37 – 40
Rep. Judy Chu (CA)’s video is played. This video was published April 2021 and shared with today’s presenters for the explicit purpose of sharing as part of this presentation.
Minute 41, More on “It Takes an Act of Congress” slide
The 2021 version of this bill has not yet been introduced to the 2021-2022 federal legislative session as of the date of this talk.
Old bill # for 2019-2020 session was HR 1183
Legislative director for Rep. Judy Chu (CA) is Ellen Hamilton
“270 days after passage”, Kallie notes, is standard language for this type of legislation
Minute 46: The Path to Passage
CBO = Congressional Budget Office
An analysis of what it would cost the federal government to run the proposed program
From the CBO website:
“A cost estimate states the likely effects of proposed legislation on the federal budget—compared with what future spending and revenues would be under current law.
“CBO is required by law to produce a formal cost estimate for nearly every bill that is approved by a full committee of either the House or the Senate…. CBO also produces formal cost estimates at other stages of the legislative process if requested to do so by a relevant committee or by the Congressional leadership. Moreover, CBO produces informal cost estimates for a much larger number of legislative proposals—including some that Congressional committees consider during the process of developing legislation, and some that receive consideration at other stages in the legislative process.”
Source: https://www.cbo.gov/faqs#costestimates
Review of how a bill becomes a law in endnote here[i]
ASA = American Society of Acupuncturists is a national professional association for licensed acupuncturists in the U.S. https://www.asacu.org/ As of October 8th, 2021, NCCAOM has partnered with ASA to also offer more training in federal advocacy for LAcs. This supports the work Kallie has started with AcuCongress. If you have the time, you are recommended to attend all the training(s) that fits your schedule.
minute 48: Timeline slide
State advocacy often has shorter timelines
Federal advocacy is a marathon. Rep. Chu has already been introducing bills for the past 8 years
minute 49-54 AcuCongress, the advocacy movement
AcuCongress is an advocacy movement for all advocates of acupuncture
Federal virtual fly-in December 8th, 2021
Kallie is the director of AcuCongress
AcuCongress is currently running an early bird special
Minute 48-50 Concerns about a portion of Rep. Judy Chu’s bill that include an explicit list of healthcare conditions vs. general language.
This creates limitations for LAcs but not others that practice acupuncture.
Kallie prefers for this to be handled in rules and regulations coming out of CMS instead of heaving an explicit list of conditions included in an Act of Congress
Minute 51 The AcuCongress is housed within the Atlantic Symposium
The Atlantic Symposium Nov. 7th-9th, 2021
AcuCongress is an advocacy movement for all advocates of acupuncture
AcuCongress is housed within the Atlantic Symposium.
The Atlantic Symposium is Nov. 7th – 9th, 2021 in South Carolina.
More information about AcuCongress will be available at the Atlantic Symposium.
There is a special federal virtual fly-in schedule or AcuCongress on December 8th, 2021. (save the date)
9.23.2021 update—If you are a part of the HHP community, the Atlantic Symposium has offered this code to use as a discount when you register: HHP2021
minute 52 End slide
Guest speaker’s contact information
Dr. Kallie Byrd Guimond, OM.D, MPH
Federal Lobbyist, Sustainable Influence, LLC
AcuCongress Director & Fly-In Coordinator
The Medicare billing conversation for hospital and healthcare system LAcs and program managers
is a separate conversation from our 4.14.2021 event.
If you are an LAc or program manager who works with LAcs and want to join the conversation and share your success stories, etc., we have a specific online discussion & resource module for this.
To join that discussion resource, send me a message via the HHP website with
your interest
where you work
your role, and
your sponsor/peer who vouches for you.
Endnotes—these are limited because of formatting issues. The full endnotes are in the pdf.
[i] A review of the process in the U.S. of how a bill becomes a law from the govtrack.us website: https://www.govtrack.us/how-a-bill-becomes-a-law
[i] History of the SSA from the SSA.gov website: https://www.ssa.gov/history/index.html
From the SSA’s policy webpage is this article, “Social Security: A Program and Policy History” by Patricia P. Martin and David A. Weaver, Social Security Bulletin, vol 66, no. 1, 2005. Published as part of the 70th-anniversary celebration of the SSA. https://www.ssa.gov/policy/docs/ssb/v66n1/v66n1p1.html
Why this Act of Congress bill is important to the hospital-based acupuncturist community, program managers, and students of acupuncture and integrative health programs
Quotes from the session
“What I have found is, when you’re working in hospital-based practice or healthcare system practice, you will eventually come to the issue of ‘why can’t we do that?’ And often what that comes down to is that you’re just not included in that language. Or you’re not included in the federal legislation language that allows you to do that.”
“What’s good about HHP community discussion is that it helps the community narrow down [what is known] and come up with [develop] good questions. Because when you have good, clearly defined questions, it is easier to find answers to them.”
Lesser-Known Benefits of inclusion as a provider type in the U.S. Social Security Act (SSA)
One of the things we learned in the April 2021 Issues in HP presentation (paraphrase):
CMS funds residency programs in hospitals. Most of the funding for residency programs in hospital settings comes from CMS.
CMS only funds residency programs for provider types recognized/listed as distinct provider types in the Social Security Act.
Reference to learn more about CMS funding of residency programs:
Committee on the Governance and Financing of Graduate Medical Education; Board on Health Care Services; Institute of Medicine; Eden J, Berwick D, Wilensky G, editors. Graduate Medical Education That Meets the Nation's Health Needs. Washington (DC): National Academies Press (US); 2014 Sep 30. 3, GME Financing. Available from https://www.ncbi.nlm.nih.gov/books/NBK248024/