Senate Bill Would End $1,500 Medicare Cap For the past two years, speech-language pathologists and audiologists who deliver services under Medicare have had a temporary breather from the $1,500 cap affecting Part B outpatient therapy services. Grassroots pressure from ASHA members, allied health professionals, and consumers convinced Congress to grant a moratorium on the cap for 2000 ... Policy Analysis
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Policy Analysis  |   September 01, 2001
Senate Bill Would End $1,500 Medicare Cap
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   September 01, 2001
Senate Bill Would End $1,500 Medicare Cap
The ASHA Leader, September 2001, Vol. 6, 1-15. doi:10.1044/leader.PA1.06172001.1
The ASHA Leader, September 2001, Vol. 6, 1-15. doi:10.1044/leader.PA1.06172001.1
For the past two years, speech-language pathologists and audiologists who deliver services under Medicare have had a temporary breather from the $1,500 cap affecting Part B outpatient therapy services. Grassroots pressure from ASHA members, allied health professionals, and consumers convinced Congress to grant a moratorium on the cap for 2000 and 2001, which was later extended to 2002. But in 2003, when the moratorium ends, the cap could again limit access to services--unless it is permanently repealed.
Earlier this month, Sen. John Ensign (R-NV) introduced two bills that would permanently repeal the $1,500 cap (S. 1394) and allow speech-language pathologists in private practice to bill Medicare directly (S. 1395).
“The $1,500 Medicare cap limited services in a way that was contrary to the intent of the Medicare program--to provide ‘reasonable and necessary’ services,” said Becky Sutherland Cornett, chair of ASHA’s Governmental Relations and Public Policy Board.
When the cap took effect in 1999, it brought job losses to SLPs and a sharp reduction in Medicare outpatient therapy services. To make matters worse, Medicare beneficiaries were forced to choose between receiving speech-language pathology and physical therapy services because those were combined into a single cap.
The repeal effort will be strengthened by earlier support in Congress to remedy the cap. In 1999, Rep. Richard Burr (R-NC) and Sen. Charles Grassley (R-IA) introduced bills that provided exemptions allowing access to medically necessary treatment for patients who exceeded the $1,500 limit. Those bills found broad support.
Expanding Access
As a companion to S. 1394, Sen. Ensign introduced legislation that would provide Medicare beneficiaries greater access to speech-language pathology services. S. 1395 would correct a technicality in the Medicare law to enable SLPs to obtain Medicare provider numbers to bill directly through private practice settings. S. 1395 also would separate speech-language pathology services from physical therapy services under Medicare, providing a separate cap for speech-language pathology services if the $1,500 cap is not repealed.
“SLPs will have the opportunity to bill Medicare independently as recognized health care providers,” Cornett said. “They will not have to be employed by a clinic or hospital, or obtain special designation as a rehabilitation agency to be eligible to provide Medicare services.”
Consumers in rural areas are most likely to benefit from the change. “Often, residents of rural communities do not have ready access to hospitals and clinics, but there may be a local SLP in a small town or village who can meet their treatment needs,” Cornett said.
What You Can Do
Ask your legislators to support S. 1394/1395. Visit ASHA’s Web site. The Action Alert that is posted in the Legislative section of the Resource Center includes talking points that can be used in sending a personalized letter to your legislator.
For more information on S. 1394/1395, contact Reed Franklin through the Action Center at 800-498-2071, ext. 4473, or email rfranklin@asha.org.
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September 2001
Volume 6, Issue 17