If you missed NASL’s 2018 Winter Legislative & Regulatory Conference last week in Washington, DC, you missed a lot. Another conference with record-breaking attendance was just the start. The conference featured a stellar lineup of speakers and panel discussions on key and emerging issues with discussions and insights attendees have reported to be “incredibly helpful.”

On Monday, February 5, NASL began the Winter Conference with a discussion on “Current Trends & Future Drivers in Skilled Nursing & Post-Acute Care” led by Founder & Strategic Advisor to the National Investment Center for Seniors Housing & Care (NIC) Robert Kramer. Kramer flagged key drivers as care delivery in the home as well as value, partnerships and risk, in addition to the “Silver Tsunami” emphasizing “transitions” not retirement.

Following our dive into some of the current trends in the SNF and PAC sector, NASL heard directly from the National Coordinator for Health Information Technology, Don Rucker, MD. His keynote presentation, “With Health IT, the Future is Now – A Keynote by America’s Top Health IT Official” covered how HHS is working through ONC to facilitate patient access to their health information and how to leverage health IT to improve population health. Dr. Rucker also dialogued with NASL members about how emerging standards and technology are driving innovation and quality improvement, and he shared ONC’s view of LTPAC’s role in the nation’s health IT landscape. 

After a welcome networking break, NASL members heard from a key Hill staffer, who’s been part of the team that drafted the Therapy Cap repeal language. We learned that – with a lower Congressional Budget Office (CBO) score for therapy cap repeal and reports from the field that the current targeted medical review process is working well for providers and patients – THIS was our opportunity to repeal the caps. Additionally, Committee staff indicated that there is interest in future discussions on functional limitation reporting.

After such an intense afternoon, we were grateful to gather for NASL’s “Party with the Presidents” Opening Night Reception. While the presidential-themed reception went on at The Rural Society in the Madison Hotel, across town, some NASL members were treated to a private, after-hours, tour of the US Capitol led by Representative Barry Loudermilk (R-GA). 

The conference resumed on Tuesday morning with NASL’s Medical Services Committee in-person meeting. NASL Executive Vice President Cynthia Morton kicked off the meeting with some exciting legislative news that had broken overnight – the House of Representatives had included full and permanent Medicare Part B therapy cap repeal language into the Continuing Resolution (CR) that passed in the House! Cynthia then explained exactly what was included in the House-passed bill, and what it meant for NASL advocates planning on Hill visits the next day. After that brief update, Cynthia moved on to discuss the voluntary NASL Survey on the “Use of the New OT & PT Evaluation Codes.” Next, Jane Moffett from Cassamba and Josh Pickus from Optima shared their insights and findings on RCS-1 from both the provider and business standpoints. The Medical Services Committee meeting wrapped up with a lively Therapy Discipline Panel discussion moderated by NASL Manager of Legislative & Regulatory Affairs Michael Barnett. Representatives from the American Physical Therapy Association (APTA), the American Occupational Therapy Association (AOTA) and the American Speech-Language and Hearing Association (ASHA) discussed their respective organization’s upcoming regulatory and legislative priorities for 2018. 

Next, NASL members heard from two analysts from the Centers for Medicare & Medicaid Services (CMS) – Shamier Casselle, CMS Program Analyst, and Elizabeth McKenna, CMS Social Science Research Analyst. The two shared CMS’ plans to completely overhaul the current Quality Improvement & Evaluation System (QIES) and Automated Survey Processing Environment (ASPEN) systems used for data submission and reporting and its QTSO.com site. After a short presentation, attendees broke out into workgroups to talk with other CMS researchers about these projects. Since CMS is taking a User Centered Design (UCD) approach in creating its new platform, NASL was the first to weigh in with the team about what works and what’s needed in the new platform. 

Following a delicious lunch, it was time for the NASL IT Committee face-to-face meeting. After a brief legislative and regulatory update, Ted Prettyman from Sims Strategies led a robust discussion on ONC’s proposed Trusted Exchange Framework & Common Agreement (TEFCA). Next, the Committee heard from Beth Connor, who is a nurse consultant and lead on CMS’ efforts on the Data Element Library (DEL), which is expected to be released later this year.

After the IT Committee discussions, conference attendees welcomed another key CMS official, Tara McMullen, MPH, who is CMS’ lead on implementation of the IMPACT Act. Tara informed NASL members about CMS’ next efforts to develop standardized assessment data and also previewed version 3 of the Transfer of Health measure, which is changing to Transfer of the Medication profile. She also emphasized that some standardized patient assessment data was not finalized in the round of payment rules. Tara noted that the CMS Administrator’s “Patients Over Paperwork” initiative impacted the number of measures CMS is rolling out – decreasing the number of measures. Responding to questions, Tara indicated that Section G of the MDS is still being used for payment and so to replace Section G with Section GG of the MDS may not be possible for now. Section GG was deemed the “most reliable section” with at least four outcome measures relying on this section for items and those outcomes measures have been standardized. Finally, she reported that work continues on a cognitive measure which is proving to be very difficult. 

We started the final day of the Winter Conference with a Legislative & Regulatory Update from NASL Policy Counsel Michaela Sims and NASL’s own Cynthia Morton. The policy update highlighted key issues and significant legislative victories that NASL has secured over the past year. It also served as a forum to make sense of all the confusing politics that we’ve experienced in 2017, and that we’re likely to experience in 2018. The update covered the latest on the Medicare Part B therapy cap permanent repeal policy; TRICARE and the legislative victory regarding therapy assistants becoming authorized providers under the TRICARE payment system; the movement away from mandatory bundling; and the growing support for telemedicine. Other topics flagged by Cynthia and Michaela included MedPAC, the Home Health Groupings Model (HHGM), the Advanced Bundled Payment for Care Initiative (BPCI-A), the Requirements for Participation (RoPs), Accountable Care Organizations (ACOs), Chronic Care Management CPT Codes and FY2018 spending by Congress and Medicaid reform.

The last item on the Winter Conference agenda was final preparations for Hill visits. Cynthia, Michaela and Michael shared tips for successful advocacy efforts, the “Do’s and Don’ts” of lobbying and answered any clarifying questions posed by NASL advocates. With the meeting adjourned, NASL members reconvened on Capitol Hill, which was abuzz with excitement over the pending vote on a Continuing Resolution, including permanent repeal of the therapy cap – a legislative win 20 years in the making!