By Roxann Mayros, President & CEO, VisionServe Alliance
In my blog posted on May 21st, I provided background information to help explain why professional services provided to people with vision loss by vision rehabilitation therapists, orientation and mobility specialists, and low vision therapists are not reimbursed by Medicare or medical insurance (third-party payers). Even though the effort to see these professionals reimbursed began in 1990, and there was a five-year Demonstration Project to prove the efficacy of these professionals, they still do not qualify for reimbursement in 2018. We learned many lessons during the very expensive and decades long effort. We hope that the following “lessons learned” will guide future endeavors to see this very important category of nationally certified professionals recognized and reimbursed by third-party payers.
- University degree programs must move. Medicare is a medical model – it does not recognize, nor does it reimburse professionals with special education degrees. University programs providing degrees in vision rehabilitation therapies with a focus on adults, must be housed in the Department of Allied Health Professions and provide degrees in Orientation & Mobility, or Vision Rehabilitation Therapy, or Low Vision Therapy, and not special education.
- The current system for referrals must change. Most referrals currently come from State Agencies for the Blind, and they are not reimbursable by third-party payers. Referrals from Ophthalmologists, Optometrists, or other medical doctors are reimbursable. Medicare and other third-party payers require that the patient be under the care of a physician while therapies are being administered. The physician must certify the patient’s need for services, and sign-off on the plan of care and follow-up that includes evidence-based outcomes that include written progress notes and a summary.
- Ophthalmologists, Optometrists, and even Occupational Therapists, must “buy-in” and be supportive. Legislators know the organizations representing these medical professions and they will ask if they are in support. During the early days of our campaign, we did not seek their involvement or understanding, so they literally advocated against reimbursement for vision rehabilitation professionals. In the last campaign before the Medicare Demonstration Project, we were far more inclusive, asking for advice, bringing representatives on visits with us to legislative offices, and more. It wasn’t easy – it took a lot of convincing that there would be a benefit to their professions before they came out in support.
- Medicare recognizes State licensing which they believe assures “quality” of the service providers (medicarenow.org). It took a lot of lobbying and negotiating with the Centers for Medicare and Medicaid (CMS) – and it will again – to recognize ACVREP certification during the Demonstration Project. We are still the only profession that has ever received reimbursement based on national certification instead of State licensing.
- The legislative process is long, expensive, and arduous. It will take several attempts and several years to find a champion/s to support the bill, bi-partisan support, a good lobbyist to shepherd and advise, traversing the review and hearings process by appropriate (sub)committees of both the House and Senate, and to bring enough advocates together to make an impact. And you better hope that your champion is re-elected, or you will start all over from the beginning.
- Cost savings must be proven, so studies are necessary. Experts sanctioned by Congress must be hired to study the impact and cost of reimbursing vision rehabilitation professionals, and to produce recommendations and/or administrative actions to legislative (sub)committees. These studies have been impacted in the past by the lack of data and evidence-based outcomes in relation to vision rehabilitation.
- Lobbyists are a necessity. No lay-man, grass-roots advocate, or vision rehabilitation professional has the necessary connections at the Federal level, nor the knowledge required, to “get meetings with the right people,” or to initiate and move a Bill through Congress. Lobbyists know the system, and they know how to make it work. They know how to write appropriate language for a Bill, how to get it filed and numbered, who in Congress works with whom, how committees work, and more. Even though expensive, they are an absolute necessity!
- It requires “boots on the ground.” Getting a bill passed cannot be done by writing letters, leaving messages, or visiting a legislator once. It has to be done in person in legislators’ offices in Washington, D.C. Advocacy must be done frequently, with urgency, and by more than a small cadre of devotees.
- It takes a dedicated and full-time staff. As explained above, it is necessary and time consuming to find enough money for studies and lobbyists, getting the right people on the bus, using a data base to track progress or next steps, organizing on-site advocacy days/meetings, seeking support from allied health professionals, meeting with legislators and their aids, organizing policy forums and Congressional updates, producing written materials, understanding the legislative process, writing press releases or journal articles, attending (hundreds if not thousands) of meetings, and shepherding a bill through Congress. None of this can be accomplished without one or more full-time staff positions.
The bottom line is that it is morally and professionally “right” to reimburse Master degreed and nationally certified Vision Rehabilitation Therapists who teach people how to live independently, Orientation and Mobility Specialists who teach travel skills using a white cane or guide dog, and Low Vision Therapists who teach how to use remaining vision and specialized tools to remain independent. I end this by challenging University programs to move degree programs from Education to Allied Health, current leaders to develop national standards and evidence-based outcomes, and to all of you to successfully shepherd a bill through Congress that will order CMS to amend Medicare law to add a new category of services provided by vision rehabilitation professionals!