Therapy Caps, Fee Cuts Return Congress To Reconsider Medicare Bill in July Policy Analysis
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Policy Analysis  |   July 01, 2008
Therapy Caps, Fee Cuts Return
Author Notes
  • Ingrida Lusis, director of federal and political advocacy, can be reached at ilusis@asha.org or 202-624-5951.
    Ingrida Lusis, director of federal and political advocacy, can be reached at ilusis@asha.org or 202-624-5951.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   July 01, 2008
Therapy Caps, Fee Cuts Return
The ASHA Leader, July 2008, Vol. 13, 1-9. doi:10.1044/leader.PA.13092008.1
The ASHA Leader, July 2008, Vol. 13, 1-9. doi:10.1044/leader.PA.13092008.1
Despite last-minute efforts by congressional proponents, the Senate failed to pass legislation to avert a 10.6% reduction in Medicare outpatient reimbursement rates and extend the therapy cap exceptions process before its July 4 recess. Effective July 1, therefore, Medicare beneficiaries are subject to therapy caps on outpatient treatment and audiologists and speech-language pathologists will see a significant decrease in their Medicare reimbursement rates.
The restrictions are due to the expiration of the Medicare, Medicaid, and SCHIP Extension Act of 2007. That legislation, passed in December 2007, suspended implementation of the provisions from Jan. 1 to June 30.
Medicare providers should anticipate that therapy caps and Medicare fee schedule rate cuts will be in effect for at least a couple of weeks while Congress works on a longer-term legislative compromise. However, to lessen the impact of the impasse, the Centers for Medicare and Medicaid Services (CMS) has instructed contractors not to process any provider claims for the first 10 business days of July. By holding claims for services delivered on or after July 1, CMS will not make any payments based on the 10.6% reduction until July 15, at the earliest. All claims for services delivered on or before June 30 will be paid as usual.
The current therapy caps are set at $1,810 for combined outpatient speech-language treatment and physical therapy, and an additional $1,810 for outpatient occupational therapy services. A Medicare Learning Network Article on the resumption of the caps is available on the U.S. Department of Health and Human Services’ Web site [PDF].
Legislation Trail
With overwhelming bipartisan support, the House of Representatives passed H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, by a vote of 355–59 in late June. The Senate, with a vote of 58–40, failed to secure the 60 votes needed on a procedural measure to advance the bill to a vote on the Senate floor. Senate leaders vowed to bring the House-passed bill back up for a vote when Congress returns to work the week of July 7.
The bill provided for a modest increase—rather than a 10.6% decrease—in the physician fee schedule and extended the therapy cap exceptions process through Jan. 1, 2010. The legislation also recognized SLPs as Medicare suppliers, thereby allowing SLPs to bill from a private practice, and recognized audiologists as eligible to participate in Medicare’s Physician Quality Reporting Initiative (PQRI). Under PQRI, providers reporting approved quality measures to CMS are eligible for a bonus payment.
To offset the high costs of the measures, the legislation proposed cuts to Medicare Advantage (MA) private fee-for-service plans. The White House stated that it would veto any legislation that contained the MA provision and many Republican senators supported that view.
For further information about the therapy caps exceptions process, go to the Therapy Cap Advocacy Center or contact reimbursement@asha.org.
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July 2008
Volume 13, Issue 9