Indiana Dietetic Association Legislative Update

1. Indiana Dietetic AssociationLegislative Update Martha Rardin, MSM, RD, CD Indiana Public Policy Coordinator

2. Future of Healthcare Professions is determined by the Congress of the US, not Associations, your education, or your professional career.

3. From: Private Ins-35% Medicare-17% Medicaid-16% Out-of-pocket-14% Other Public-12% To: Hospitals-31% Docs-22% Drugs-11% NH-7% Other-22% Adm-7% Who Pays For Healthcare?

4. Medicare • Federal Health Insurance Program (1965) • CMS Administers • 65, <65 and legally blind, or disabled, End State Renal Disease (ESRD) • Part A (Hospital and Nursing Home) • Part B (Outpatient) • Part C (Insurance companies contract with Medicare for HMO and PPO coverage) • Part D (Drug Prescription Coverage)

5. Medicaid • Joint Fed and State Program • Medical costs for low/limited income • Vary from state to state

6. Who Pays For Healthcare? • Medicare • 50% goes to Hospitals and Skilled Nursing Facilities • Funds 17% of Long Term Care (nursing homes) • Federally funded • Medicaid • State funded • Funds 47% of Long Term Care

7. IS Universal Health Care the Answer? • Will Universal Health Care solve our healthcare woes? • Is a Public Option viable? • Who pays for access? • Will taxpayers be taxed more? • Will users of healthcare pay any premiums? • Watch the healthcare debate carefully!

8. Influencing Policy

9. Lobbying = Marketing • Need Access to politicians • All Politics Is Local • Provide Local Influence • Provide Local Insight • Provide Local Experiences • Communicating Effectively • Who, Why, What, Where, When • Attend Town Hall meetings or visit your elected officials • Long Term Relationship (give and take) • Making friends outside of your circle and interest

10. Those who choose to be players Those who choose to be victims Two Kinds Of People

11. Those who choose to be players They vote. Communicate with lawmakers on issues that directly concern them. They communicate with email or by meeting with officials when they are on recess. Help elect candidates who best represent them. Those who choose to be victims They do not vote (or only vote). They live with the political decisions that others are able to influence. They don’t understand the political process and just want someone to “fix it”. Two Kinds Of People

12. Influence Policy • Persuasion • Have the Knowledge • Political Power • More Impt than Facts • How to get it? • You have to be a player

13. Political Power • 36% don’t vote • 23% not registered • 24% underage • 17% decide!

14. Political Power YOU have Power! • Individual Contribution (up to $2,300) to each candidate per election • Political Action Committees PACS may give up to $2,300/election/candidate • National parties may contribute up to $5,000/election • Politicians are always running for office and always raising money – donate regularly

15. Who Is My Legislator? • www.accessIndiana.gov • Type in elected office • Type in zip code

16. From Idea to Law by the “Book” Member of Congress House Full Committee Subcommittee Full Committee Senate House Full Committee Subcommittee Full Committee Senate Senate House Conference Committee President Public Law Veto Senate House

17. How to get a bill passed • Constituent input to “right” Rep. or Senator • Facts to support debate • Understand Congressional timetables • Understand Congressional committee assignments • Build support over period of time, most bills do not pass first time they are introduced • Bills introduced in one Congress are not extended to the next, but must be reintroduced—all bills die when Congress adjourns.

18. How to communicate with your congressman or legislator • Email is best • Legislators don’t get a lot of mail from constituents • May or may not receive a response • Make your message concise, polite, and ASK for their support for or against your issue • Provide facts but not stacks of facts • Provide data on how this affects his/her constituents

19. What can you do? • VOTE • Vote in every primary, school board election, general election • Volunteer for your candidate • Donate money to a candidate • Place a sign in your yard or window • Read the paper and follow current events daily

20. American Dietetic Association What have you done for me lately? OR What have YOU done lately for ADA?

21. ADA’s #1 Goal • Be included in Health Care Reform Legislation! • Physicians know nutrition therapy can improve health outcomes • Lack of physician reimbursement is the reason 80% of physicians cite for not addressing nutrition services • Chronic disease accounts for 75% of the $2 Trillion spent annually on healthcare Nutrition has been shown to be highly cost-effective in preventing and managing chronic disease – but nutrition services is usually not a routine covered benefit. ADA Times, Summer 2009, Volume 6, Issue 4

22. ADA’s Public Policy Goals • Food and Nutrition Is Key To Health • Advocate for Public Health and Profession • Safe and Nutritionally Adequate Diet For All. • Based on Science • Disease Prevention and Treatment • Evidence-based MNT

23. ADA’s Public Policy Priorities • Aging • Child Nutrition • MNT (Medicare and Medicaid) • Nutrition Monitoring • Nutrition Research • Obesity and Weight Management • State Issues

24. ADA’s Public Policy Update • Aging (Older Americans Act-entitlement program) • Child Nutrition (WIC-entitlement program) • Medical Nutrition Therapy (want this expanded beyond diabetes coverage) • Nutrition Monitoring (want this expanded and funded) • Nutrition Research (want this expanded) • Obesity and Weight Management-monitor • State Issues-monitor

25. Some Issues we watch at PPW • Medicaid • Medicare • MNT Act of 2005 • Ryan White Care Act • Older Americans Act • Dietary Guidelines • Obesity • Farm Bill • State statutes on certification and licensure

26. 2005 Dietary Guidelines • Federal Nutrition Policy/Programs • HHS/USDA Legislative Every 5 Years • Science-based • Currently under revision but needs increased funding • Promote healthy, prevent chronic disease

27. So what’s the problem with reimbursement? • Unfortunately long term studies involving the success of prevention are in short supply. • The Congressional Budget Office (CBO) only recommends coverage for procedures/interventions that can PROVE cost savings. • The CBO uses a 10-year period to determine cost effectiveness. • As RD’s we know 10 years may not be enough time to illustrate the savings in the long-term due to the prevention of complications. • A lack of research is contributing to our lack of reimbursement.

28. So what’s the problem with reimbursement? • Diabetes prevention and treatment programs that incorporate screening, education and nutrition counseling are effective but many times the effectiveness of complication prevention may exceed the 10 year window. • Rep. Donna Christensen (D-VI) has introduced legislation that would allow the CBO to score preventative health services using a 25-year window. • ADA has signed on to support this initiative. Source: ADA’s On The Pulse, 9/4/09

29. ObesityIRS • Allowable Medical Expense Deductions: • In total medical deductions amt pd for weight loss IF Tx for disease diagnosed by MD (obesity, HTN, CVD) • Bariatric Surgery, MNT, Approved Drugs • Fees at gym for separate activities • Special foods only beyond normal needs

30. ObesityCMS • Has NOT designated obesity as disease • “Treatments for obesity alone remain non-covered and coverage for treatments resulting in or exacerbated by obesity remain unchanged.” • “Services in connection with the treatment of obesity are covered when services are an integral part of a course of treatment for a medical condition such as hypothyroidism”.

31. Current and Past Issues • Indiana School Food Quality Bill • Physician’s Reimbursement? • Certification Status

32. Licensure or Certification? • Licensure defines scope of practice - defines what you can and cannot do as a dietitian • Certification defines the profession - the educational requirements for someone to call themselves a dietitian • Certification does not define scope of practice • Licensure is preferable but difficult to enact.

33. Indiana has Dietitian Certification • Dietitian Certification Application Form • http://www.in.gov/icpr/webfile/formsdiv/47586.pdf • Dietitian Certification-Title 830 • http://www.in.gov/legislative/iac/iac_title?&iacv=iac2003&iact=830&iaca=all • Displaying Dietitian Certification Certificate • http://www.in.gov/legislative/ic/code/title25/ar14.5/ch4.html

34. The Pitch! • Legislative Involvement It is up to you and I! • Public Policy Workshop • Day at the State House • YOU are the dietetic professional – YOU have to speak up for your interests!

35. Resources • On The Pulse • www.eatright.org • www.dietetics.com/ida • ADA’s Medicare MNT Provider Newsletter

36. Thank You!Martha Rardin, MSM, RD, CDIDA Public Policy Coordinatormjrardi@hendricks.org317-745-3768