Year-End Advocacy Needed on Medicare: Changes Loom in Fee Schedule, Medicare Caps As the year comes to a close on Capitol Hill, ASHA is still fighting for a reversal of two key legislative issues. On Jan. 1, 2008, current law will cut payment rates under the 2008 Medicare Physician Fee Schedule by an average of 10%, and the exceptions process for the ... Policy Analysis
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Policy Analysis  |   November 01, 2007
Year-End Advocacy Needed on Medicare: Changes Loom in Fee Schedule, Medicare Caps
Author Notes
  • Elizabeth Mundinger, director of federal and political advocacy, can be reached at emundinger@asha.org.
    Elizabeth Mundinger, director of federal and political advocacy, can be reached at emundinger@asha.org.×
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   November 01, 2007
Year-End Advocacy Needed on Medicare: Changes Loom in Fee Schedule, Medicare Caps
The ASHA Leader, November 2007, Vol. 12, 1-4. doi:10.1044/leader.PA.12162007.1
The ASHA Leader, November 2007, Vol. 12, 1-4. doi:10.1044/leader.PA.12162007.1
As the year comes to a close on Capitol Hill, ASHA is still fighting for a reversal of two key legislative issues. On Jan. 1, 2008, current law will cut payment rates under the 2008 Medicare Physician Fee Schedule by an average of 10%, and the exceptions process for the Medicare outpatient therapy caps will expire. Congress is expected to pass legislation to address these impending changes, but it is unclear what the final legislation will include—and whether Congress will pass the bills before Dec. 31.
Medicare payment rates for outpatient speech-language pathology and outpatient audiology services in private practice settings and physicians’ offices are determined by the Medicare fee schedule. As a cost-containment measure, Congress passed a law in 1997 providing that fee schedule rates be cut whenever actual expenditures exceed projected expenditures. Unfortunately, expenditures have exceeded projections every year since 2002. Payment rates were cut in 2002, but from 2003–2007 Congress suspended the cuts. Each year the scheduled cut grows larger and it becomes harder for Congress to find a way to pay for a suspension. ASHA staff and members have been urging legislators to replace the scheduled cut with a positive update that reflects increased practice costs.
ASHA has also been pressing Congress to extend the Medicare outpatient therapy cap exceptions process. In 2007, outpatient speech-language pathology and physical therapy, combined, are capped at $1,780 per patient. Fortunately, Congress created an exceptions process that allows speech-language pathologists and others to provide care beyond the cap when medically necessary. If the exceptions process is allowed to expire on Dec. 31, patients—especially those with serious neurological conditions or multiple injuries—may not be able to get the treatment they need.
Members have aided these advocacy efforts by participating in ASHA’s Stop the Cap Call-In Days on Oct. 31 and Nov. 1, which coincided with the Stop the Therapy Caps Advocacy Day in Washington D.C., cosponsored by ASHA. Legislators, patient advocates, SLPs, and other therapy providers joined forces to speak up for patients’ needs. Sen. John Ensign (R-Nevada)—who introduced bills to repeal the outpatient therapy caps and to allow SLPs to directly bill Medicare—spoke at the event.
“Therapy is essential to the successful rehabilitation of seniors suffering from conditions such as stroke, Parkinson’s disease, and congenital heart failure,” Ensign said. “Congress has demonstrated its opposition to these arbitrary limitations year after year. It’s time to act for our seniors and ensure that they receive the rehabilitation services they need.”
Despite intensive lobbying, it is unclear whether Congress will act on these issues before Dec. 31. On Aug. 1, the House passed a Medicare package that addresses both of these impending problems and many other issues important to ASHA. It would halt the scheduled cut to the fee schedule and provide for an average increase of 0.5% in both 2008 and 2009. The House bill also would extend the Medicare outpatient therapy cap exceptions process for two years.
In addition, the House Medicare package would give SLPs independent supplier status, allowing private practitioners to bill Medicare directly. The legislation also would prevent the White House from fully implementing the “75% rule” on inpatient rehabilitation facilities. However, at press time, the U.S. Senate had not yet acted on this Medicare package.
Please contact your legislators and urge them to pass these important provisions before the end of the year. Draft e-mails and talking points on these issues can be found at takeaction.asha.org.
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November 2007
Volume 12, Issue 16