Medicare Caps Go Back to Court Advocacy Builds on Capitol Hill Policy Analysis
Policy Analysis  |   October 01, 2003
Medicare Caps Go Back to Court
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   October 01, 2003
Medicare Caps Go Back to Court
The ASHA Leader, October 2003, Vol. 8, 1-19. doi:10.1044/leader.PA.08182003.1
The ASHA Leader, October 2003, Vol. 8, 1-19. doi:10.1044/leader.PA.08182003.1
Implementation of the Medicare therapy caps on Sept. 1 has galvanized opponents as the battle continues on the judicial and legislative fronts. ASHA continues to press in court for a delay on the current caps, and on Capitol Hill to gain a repeal or moratorium for 2004. The caps on outpatient services provided under Medicare Part B affect beneficiaries needing speech-language pathology, occupational, and physical therapy services. A combined cap on speech-language pathology and physical therapy services allows patients only $1,590 worth of services in an entire year.
Medicare beneficiaries and health care providers are one step closer to a 2004 cap moratorium after a joint House-Senate conference committee agreed on Sept. 9 to include the language on the cap moratorium in their consideration of a final Medicare bill. Other more controversial provisions have not been reconciled between the House and Senate bills, but the moratorium proved to be common ground.
“The fact that this is considered non-controversial reflects effective advocacy by our members and other patients’ advocates,” said President Glenda Ochsner. “This issue has broad support in both parties in both the House and Senate.”
The Medicare bill, however, is far from becoming law. “The conference still must address some deeply divisive issues, such as privatization of Medicare, and whether they will reach an accord is open to question,” said Ochsner. “If these issues aren’t resolved, the bill as a whole may fail, and the moratorium could get pulled down with it.”
Court Battle Continues
On Sept. 15, ASHA went back to court with other patients’ rights groups. Plaintiffs and defendants in the therapy cap litigation appeared before U.S. District Court Judge Emmet Sullivan (see the August 5 issue of The ASHA Leader for coverage of the first court hearing before Sullivan). Opponents of the caps argued that the Centers for Medicare and Medicaid Services (CMS) had not met its obligation under the settlement that first delayed implementation of the cap from July 1 until Sept. 1.
Opponents argued that CMS failed to provide sufficient notice to Medicare beneficiaries of the cap on their benefits. CMS, represented by the U.S. Department of Justice, argued that the agency had complied with the settlement agreement.
After spirited arguments from both sides, Judge Sullivan took the matter under advisement and is expected to rule in the near future. Watch for future coverage in The ASHA Leader.
Keep Up the Pressure
Contact your members of Congress to halt implementation of the Medicare therapy caps. For more information on how to contact Congress, go online and visit
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October 2003
Volume 8, Issue 18