Happy New Year! Medicare Caps Postponed Delay Offers Time to Advocate for Repeal Policy Analysis
Policy Analysis  |   January 01, 2003
Happy New Year! Medicare Caps Postponed
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   January 01, 2003
Happy New Year! Medicare Caps Postponed
The ASHA Leader, January 2003, Vol. 8, 1-28. doi:10.1044/leader.PA.08012003.1
The ASHA Leader, January 2003, Vol. 8, 1-28. doi:10.1044/leader.PA.08012003.1
ASHA and other rehabilitation and consumer groups have won a delay in implementation of the $1,500 Medicare therapy caps on outpatient services.
Tom Scully, administrator of the Centers for Medicare and Medicaid Services (CMS), informed ASHA on Dec. 24 that implementation would not occur until at least July 1, and stated that any caps put in place after that date would not be retroactive. At press time, however, CMS had not issued a fully detailed Program Memorandum, but only an announcement of the delay.
The CMS decision followed action by a coalition of groups critical of the caps. The coalition had decided to pursue a temporary restraining order (TRO) in federal court to halt implementation.
ASHA joined the effort when it became clear that Congress would not act on Medicare legislation this fall, and that the caps would return on Jan. 1 after a three-year moratorium.
“Our persistence has paid off—and by its action, CMS appears to agree with our legal analysis,” said president-elect Larry Higdon, who served as vice president of governmental and social policies during much of the cap campaign.
In particular, CMS agreed that the cap should be implemented on a beneficiary basis, not a provider basis, which the coalition argued was the specific intent of the original law, Higdon said.
“The agency concluded that it did not have the mechanisms in place to implement beneficiary caps.”
The agency also has indicated its willingness to work with Congress early in 2003 on legislation on the caps.
“ASHA applauds this development, but our battle is far from over,” Higdon said, adding that advocacy early in 2003 could make the difference between a brief reprieve and a permanent solution for Medicare beneficiaries.
CMS has indicated that a Program Memorandum announcing its decision may be issued as early as mid-January. But, added Higdon, “We’re not holding our breath,” referring to the frequent CMS delays in issuing instructions to carriers and intermediaries.
Relief—for Now
Over the last two months, The ASHA Leader has interviewed numerous speech-language pathologists serving in clinical, managerial, and executive positions in the rehabilitation industry about the expected return of the caps and the impact on beneficiaries.
CMS’ verbal notification of the six-month postponement came as this issue was going to press. But several of the SLPs originally interviewed were able to offer their reactions to this new development.
“My initial reaction is one of relief,” said Carol Winchester, director of clinical services for Genesis Rehabilitation Services. “I feel as though our patients have been spared an injustice.”
“Those who are devastated by illness and disability do not deserve to be forced to worry about saving their rehabilitation dollars,” she said. “Instead, they need to focus on improving their health and their quality of life as quickly as possible.”
Garry Pezzano, an SLP and Genesis vice president of clinical practice who has been active in ASHA’s efforts, stressed the role of grassroots advocacy.
“We learned from our first round with the caps, and we are seeing the benefits of being more politically active as clinicians and rehab providers,” he said. “In addition to communicating with legislators, we took the stance that without clear direction and systems we, as providers, were not able to implement a cap.”
Added Pezzano, “The most significant statement we put out there was that these caps are not a provider issue, but a beneficiary issue.”
Adam Steinberg, an SLP, co-owns a rehabilitation company with a specialty in spinal cord injury and traumatic brain injury and a clinical work force of 75 rehabilitation professionals.
In 1999, he recalls, his company was more Medicare dependent. “We saw a severe effect on the industry. Therapy stopped for a lot of our clients—and they were extremely frustrated and vocal with their representatives on Capitol Hill.”
When they learned about the postponement, Steinberg’s clients “were very positive. There is a general feeling of satisfaction that they have not been abandoned by the system.”
But he knows that six months can pass quickly, and that the threat remains.
“We are stepping up our advocacy, and urge others to do so. Our hope is that Congress will move quickly. Otherwise, we’ll see short-term dissatisfaction and problems with clients, and the government will have long-term expenses. It’s much more cost-effective to provide therapy when patients need it most than to put them in hospitals or nursing homes.”
Marilyn Peterson, coordinator of Rehab Services for UNS-Pruitt, said she hoped Congress would address the therapy services for Medicare Part B outpatients “in a way that will not be as punitive as the cap, and will allow us to provide medically necessary therapy as outlined in the CMS provider manual.”
The final outcome of this issue—whether the caps are implemented later this year, or whether grassroots pressure can lift them—will have long-term effects on beneficiaries, and on their providers.
“With the geriatric population expected to double by 2020, we are in dire need of more clinicians,” Winchester said.
“SLPs want to help patients get better, suffer less, and have a better quality of life for whatever time they have left. The cap goes against all that we know in our hearts to be necessary.”
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January 2003
Volume 8, Issue 1