Congress Passes Stopgap Bill on Medicare Medicare beneficiaries and their providers received a temporary respite from a threatened 21.1% decrease in Part B payments set forth in the 2010 Medicare Fee Schedule. Lawmakers could not agree prior to a Feb. 28 deadline on changes to the fee schedule and on the extension of the therapy caps ... Policy Analysis
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Policy Analysis  |   March 01, 2010
Congress Passes Stopgap Bill on Medicare
Author Notes
  • Stefanie Reeves, director of political advocacy, can be reached at sreeves@asha.org.
    Stefanie Reeves, director of political advocacy, can be reached at sreeves@asha.org.×
  • Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.
    Mark Kander, director of health care regulatory analysis, can be reached at mkander@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   March 01, 2010
Congress Passes Stopgap Bill on Medicare
The ASHA Leader, March 2010, Vol. 15, 1-17. doi:10.1044/leader.PA.15032010.1
The ASHA Leader, March 2010, Vol. 15, 1-17. doi:10.1044/leader.PA.15032010.1
Medicare beneficiaries and their providers received a temporary respite from a threatened 21.1% decrease in Part B payments set forth in the 2010 Medicare Fee Schedule. Lawmakers could not agree prior to a Feb. 28 deadline on changes to the fee schedule and on the extension of the therapy caps exception process for Part B services, but late on March 2, approved an extension of less than a month, until March 31. ASHA and about 40 provider and patient advocacy groups held a national press conference on March 3 to urge Congress to find a long-term solution for Medicare beneficiaries. ASHA views the stopgap bill on Medicare as only a short-term solution; further action is needed to find a long-term answer.
In late December legislators voted to temporarily stop the proposed cut in the fee schedule and postpone the cuts in Medicare Part B payments for 60 days past the scheduled Jan. 1 implementation date. The therapy caps exceptions process, which was not reinstated for 2010, had enabled Medicare beneficiaries who exceed the maximum therapy allowed per year ($1,860 maximum on combined physical therapy and speech-language pathology services) to continue to receive medically necessary services. Without further action by Congress, Medicare Fee Schedule cuts and continuance of the restrictive Part B therapy caps are still possible in April. Members are advised to visit ASHA’s Therapy Cap Advocacy Center for more information.
Physician Fee Schedule
The proposed 21.1% reduction in the Medicare fee schedule is the result of the formula used to establish the fees. Health care reform efforts included measures to change the calculation, eliminating the need for annual temporary legislation to avert deep cuts.
Therapy Cap Exceptions Process
Therapy caps with no exceptions process were reinstated Jan. 1 when health care legislation that addressed the issue failed to become law by the end of 2009. Representatives from a coalition of more than 40 consumer, patient, and provider groups—including ASHA—have been meeting weekly with House and Senate staffers to identify legislation that could include a provision to reinstate the therapy cap exceptions process. With the stopgap measure approved March 2, the therapy caps extension process went into effect March 3 and is due to expire March 31. Under the temporary measure, the exceptions process will be retroactive to Jan. 1.
A one-year extension of the exceptions process appeared briefly in an early draft of the Senate “jobs bill” (an economic stimulus bill that includes, among other items, job-creation provisions), but cost estimates forced lawmakers to pare down the provisions.
The coalition is focusing on efforts that would add therapy cap extension language to any legislation that also addresses the Medicare fee schedule. The coalition stresses federal legislators must ensure that both provi-der reimbursement and beneficiary access be included in any Medicare legislation. Appropriate reimbursement is essential to ensuring patient access, but other critical issues, including access to outpatient therapy services, should not be ignored.
Patient Information
ASHA members should be aware that the stopgap measure will remain in effect only until March 31, and should visit ASHA’s Therapy Cap Advocacy Center for the latest news updates. Without further Congressional action, beneficiaries will be responsible for 100% of the costs of treatment beyond the therapy limit, unless this outpatient care is furnished directly or under arrangements by a hospital. (Patients who are residents of a Medicare-certified skilled nursing facility may not receive outpatient hospital services for services over the cap.)
Providers may design their own notification form or use the Advance Beneficiary Notice of Noncoverage form (ABN, Form CMS-R-131) developed by Centers for Medicare and Medicaid Services (CMS), are available on CMs’ Web site [PDF]. As use of the CMS form in this instance is optional, the requirements related to its mandatory use would not apply. The provider should include the beneficiary’s name on the form and the reason that Medicare may not pay in the space provided. CMS suggests the following language: “Medicare will not pay for physical therapy and speech-language pathology services over $1,860 in 2010.” A cost estimate for the services may be included but is not required.
Take Action
ASHA members are urged to contact their legislators immediately to encourage them to act on the therapy caps issue. ASHA’s Take Action Web site guides users through a very quick and easy method of locating the appropriate congressional representatives and sending them a letter expressing support for reinstatement of the exceptions process.
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March 2010
Volume 15, Issue 3