Congress Delays Action on Medicare Reimbursement Speech-language pathologists (SLPs) and audiologists will face dramatic cuts in Medicare reimbursement as well as expiration of the therapy cap exceptions process effective Jan. 1, 2007, unless Congress passes Medicare legislation during a special November legislative session. Although there has been much debate on Capitol Hill regarding how to address ... Policy Analysis
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Policy Analysis  |   November 01, 2006
Congress Delays Action on Medicare Reimbursement
Author Notes
  • Elizabeth Mundinger, director of federal and political advocacy, can be contacted at emundinger@asha.org or by calling 800-498-2071, ext. 4473.
    Elizabeth Mundinger, director of federal and political advocacy, can be contacted at emundinger@asha.org or by calling 800-498-2071, ext. 4473.×
  • Ingrida Lusis, director of health care regulatory advocacy, can be contacted by e-mail at ilusis@asha.org or at ext. 4482.
    Ingrida Lusis, director of health care regulatory advocacy, can be contacted by e-mail at ilusis@asha.org or at ext. 4482.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   November 01, 2006
Congress Delays Action on Medicare Reimbursement
The ASHA Leader, November 2006, Vol. 11, 1-29. doi:10.1044/leader.PA1.11152006.1
The ASHA Leader, November 2006, Vol. 11, 1-29. doi:10.1044/leader.PA1.11152006.1
Speech-language pathologists (SLPs) and audiologists will face dramatic cuts in Medicare reimbursement as well as expiration of the therapy cap exceptions process effective Jan. 1, 2007, unless Congress passes Medicare legislation during a special November legislative session.
Although there has been much debate on Capitol Hill regarding how to address these critical issues, Congress adjourned Sept. 29 to prepare for elections without passing Medicare legislation. However, Congress is expected to reconvene the week before Thanksgiving for a lame-duck session (a session that takes place after elections but before newly elected members take office) to complete its work on unresolved appropriations bills; in addition, Medicare legislation is expected to be a high priority.
On Sept. 28, the House Energy and Commerce Committee met to discuss a possible fix to the scheduled 5.1% cut to Medicare physician payments in 2007. Committee Chairman Joe Barton (R-TX) supports revamping the current payment system, which relies on the sustainable growth rate (SGR) to determine yearly updates to the payment system. However, after multiple competing House and Senate proposals were introduced, Barton and other House leaders said it would not be feasible to develop and pass any type of payment fix before Congress recessed for the fall elections.
Separately, on Sept. 26, the Senate Finance Committee announced its plan to fix the SGR. A plan proposed by Chairman Charles Grassley (R-IA) and ranking member Max Baucus (D-MT) would give physicians a 0.5% increase in 2007 and an additional 1.5% increase beginning in July 2007, in exchange for reporting of quality measures. However, the plan essentially delays the cuts in physician payments to later years with a 12% cut in 2009 and a 13% cut in 2010, all meant to offset the cost of the increase.
It is still unclear how Congress will ultimately address the issue of Medicare outpatient reimbursement: it could delay the proposed cuts for another year; require the reporting of quality data; or totally revamp the payment update process. ASHA will continue to work with other provider groups to educate Congress on the devastating impact of the proposed cuts on all Medicare providers.
Extending Therapy Cap Exceptions
The outpatient therapy caps exceptions process is set to expire Jan. 1, 2007. The Deficit Reduction Act of 2005 required the Centers for Medicare and Medicaid Services (CMS) to develop an exception process to allow beneficiaries access to medically necessary outpatient therapy services above the therapy caps. Unfortunately, Congress mandated the exceptions process for only one year.
To address the expiration of the exceptions process, legislation has been introduced in both the House and Senate that would extend the therapy caps exceptions process through 2007 to ensure that Medicare beneficiaries who rely on medically necessary services continue to have access to those services. Sens. John Ensign (R-NV) and Blanche Lincoln (D-AR) introduced S. 3912, the Securing Effective and Necessary Individual Outpatient Rehabilitation Services (SENIORS) Act, and Congressman Phil English (R-PA) introduced the identical bill H.R. 6132 in the House.
ASHA is working with Congress not only to pass this legislation, but to also work towards a more permanent alternative to the therapy caps.
SLPs in Private Practice
ASHA continues to lobby Congress for support of legislation (S. 657/H.R. 3795) that would allow SLPs in private practice to bill the Medicare program directly. As Congress debates changes to the Medicare program, including the reporting of quality and efficiency, it is imperative that SLPs be given provider numbers so that they can actively participate in the process. All ASHA members are urged to call their senators and representative to ask them to encourge congressional leadership to include S. 657/H.R. 3795 in the larger Medicare bill that is expected to pass during the lame-duck session.
ASHA, along with many others, lobbied to have the Medicare legislation passed before Congress adjourned. It is unclear whether Congress will simply delay the Medicare reimbursement rate cuts and extend the outpatient therapy cap exceptions process or if Congress will pass provisions moving toward more permanent solutions.
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November 2006
Volume 11, Issue 15