Medicare Provisions Would Help Professions Health Care Legislation Passes House but Faces White House Opposition to Children’s Health Insurance Policy Analysis
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Policy Analysis  |   September 01, 2007
Medicare Provisions Would Help Professions
Author Notes
  • Elizabeth Elizabeth, director of federal and political advocacy, can be reached at emundinger@asha.org.
    Elizabeth Elizabeth, director of federal and political advocacy, can be reached at emundinger@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   September 01, 2007
Medicare Provisions Would Help Professions
The ASHA Leader, September 2007, Vol. 12, 4. doi:10.1044/leader.PA.12122007.4
The ASHA Leader, September 2007, Vol. 12, 4. doi:10.1044/leader.PA.12122007.4
A health care bill that includes several Medicare provisions that benefit audiologists and speech-language pathologists passed in the U.S. House of Representatives on Aug. 1, but opposition to other provisions in the bill threatens further movement. The bill (H.R. 3162) would raise Medicare fee schedule rates, extend the exceptions process for the therapy caps, allow SLPs to bill Medicare directly, and freeze the “75% rule” for inpatient rehabilitation facilities.
In addition to amending Medicare, the bill—the Children’s Health and Medicare Protection (CHAMP) Act—would reauthorize and expand the State Children’s Health Insurance Program (SCHIP).
CHAMP proposes an additional $48 billion investment over five years in the SCHIP program, which provides health insurance to children from low-income working families. The SCHIP and Medicare provisions would be funded by an increase in the cigarette tax and cuts in payments to Medicare managed-care plans.
The Senate passed its own SCHIP bill—with no Medicare provisions—which would invest $35 billion in the program over the next five years. President Bush has threatened to veto both the CHAMP Act and the Senate SCHIP bill.
Medicare Fee Schedule
Under current law, Medicare reimbursement rates are scheduled to be cut by an average of 10% at the end of 2007. The CHAMP Act would halt this cut for two years and would ensure that the fee schedule rates, on average, receive a 0.5% increase in 2008 and a 0.5% increase in 2009. This change is important to audiologists and SLPs who provide care to Medicare patients. It would also protect access to quality care for the elderly by halting cuts that could cause some providers to stop participating in the Medicare program.
Therapy Caps
Current law caps Medicare coverage for outpatient speech-language pathology and physical therapy services. However, Congress implemented an exceptions process that allows beneficiaries to receive services beyond the cap. Without the exceptions process, Medicare covers only $1,780 in combined outpatient speech-language pathology and physical therapy per year per patient. The exceptions process expires at the end of 2007; the CHAMP Act would extend the exceptions process through 2009 while the Centers for Medicare and Medicaid Services (CMS) studies alternatives to the therapy cap.
Direct Billing for SLPs
Under current law, Medicare covers outpatient speech-language pathology services, but SLPs cannot directly bill CMS for those services. Thus, private-practice SLPs cannot provide covered care to Medicare beneficiaries. The CHAMP Act would eliminate this problem by allowing private-practice SLPs to bill Medicare directly. In addition to benefiting ASHA members, the change would increase the availability of speech-language pathology services, especially in rural and minority communities.
Inpatient “75% Rule”
Under current law, CMS may disqualify inpatient rehabilitation facilities from participating in the Medicare program if less than 60% of their patients meet certain diagnosis criteria. That rate is scheduled to increase to 75% on July 1, 2008. The CHAMP Act would freeze the implementation of the so-called inpatient rehabilitation facility “75% rule” at 60%. The lower rate would help ensure that the elderly receive continued access to quality health care.
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September 2007
Volume 12, Issue 12