Cap Delayed! In Busy Week, Congress Acts on Medicare, IDEA Policy Analysis
Policy Analysis  |   July 01, 2003
Cap Delayed!
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   July 01, 2003
Cap Delayed!
The ASHA Leader, July 2003, Vol. 8, 1-14. doi:10.1044/leader.PA.08132003.1
The ASHA Leader, July 2003, Vol. 8, 1-14. doi:10.1044/leader.PA.08132003.1
In an important victory for Medicare beneficiaries receiving outpatient therapy services, the Centers for Medicare and Medicaid Services (CMS) has agreed to delay the July 1 implementation of the $1,500 Medicare cap on outpatient therapy services until Sept. 1.
Legal action by ASHA and other groups led to the postponement. On June 25, a request for a temporary restraining order against the U.S. Department of Health and Human Services, which oversees CMS, was filed on behalf of several beneficiary organizations in the U.S. District Court for the District of Columbia. ASHA was instrumental in bringing about this litigation as part of its advocacy to oppose the caps.
CMS will notify beneficiaries about the September implementation through Medicare Summary Notices. The agency also has agreed to reconcile the administration of the therapy caps with consolidated billing requirements at skilled nursing facilities.
In Congress, the House and the Senate passed differing versions of Medicare reform legislation. The House bill includes a moratorium on the cap for 2004.
The Senate bill did not include language on the cap; it included nothing but the prescription drug benefit. Senate leaders opposed all floor amendments on other Medicare issues. Sen. John Ensign (R-NV) offered an amendment to repeal the cap, but withdrew it at the request of the leadership. In exchange, Ensign received a commitment from Sen. Charles Grassley (R-IA), chair of the Finance Committee, that he would work toward a solution when the House and Senate meet in conference committee to forge a compromise.
This solution will most likely be the one-year moratorium in the House bill, effective for 2004. Grassley and Ensign entered a discussion, technically called a colloquy, into the Congressional Record memorializing this agreement. Grassley also went on the record urging CMS to delay implementation of the $1,500 caps.
On the same day that the legal action was filed to delay the cap, Congress also took action on the Individuals with Disabilities Education Act (IDEA). On June 25, the Senate Health, Education, Labor, and Pensions Committee (HELP) approved S. 1248, the Individuals with Disabilities Education Improvement Act of 2003, by a unanimous vote of 21-0.
The committee modified the personnel standards section in the bill it approved. ASHA members are very familiar with ongoing advocacy efforts to preserve the “qualified provider” language for related services providers, including speech-language pathologists and audiologists, found in current IDEA law.
Although the HELP committee’s bill improves upon the language found in the bill passed by the House (H.R. 1350), the provisions in S. 1248 weaken requirements that states hire qualified personnel. ASHA lobbyists will work to further modify the Senate bill language.
The next step in the legislative process for S. 1248 is consideration by the full Senate, but with a full legislative calendar, a date has not been set.
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July 2003
Volume 8, Issue 13