Round One Victory in Medicare Cap Fight Final Outcome Is Far From Certain, Strong Advocacy Still Needed Policy Analysis
Policy Analysis  |   July 01, 2002
Round One Victory in Medicare Cap Fight
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   July 01, 2002
Round One Victory in Medicare Cap Fight
The ASHA Leader, July 2002, Vol. 7, 1-11. doi:10.1044/leader.PA.07132002.1
The ASHA Leader, July 2002, Vol. 7, 1-11. doi:10.1044/leader.PA.07132002.1
The last few months have been an exhausting—and at times, exhilarating—roller coaster ride for those involved in ASHA’s effort to gain a congressional repeal of the $1,500 Medicare caps on Part B outpatient services.
On June 27, in a session that stretched past midnight, the U.S. House of Representatives voted 221–208 to pass a Medicare bill, H.R. 4954, that includes a two-year extension of the current moratorium on the caps. Without congressional action, the caps will return on Jan. 1, 2003—imposing a $1,500 per-year combined limit on outpatient speech-language pathology and physical therapy services. Occupational therapists would have a separate $1,500 limit on services.
Created by Congress as part of a cost-cutting measure in the Balanced Budget Act of 1997, the caps were first imposed in 1999. Strong grassroots pressure by ASHA members and other advocates led to a temporary reprieve—a two-year moratorium that was extended for an additional year, through 2002. But that reprieve ends at midnight on Dec. 31.
The H.R. 4954 provision for a two-year moratorium is part of a broader advocacy push by ASHA and other advocacy organizations that is aimed at a permanent repeal of the caps. Two repeal bills were introduced in late spring in the House and Senate—H.R. 3834 and S. 1394—and ASHA’s Legislative Councilors traveled to Capitol Hill in early June to urge their elected officials to cosponsor those bills.
Now is the time to write and visit your representatives to press for the cap’s repeal. (See sidebar at right.)
Targeting Vulnerable Beneficiaries
This is a high-stakes political battle over health benefits for some of the nation’s most vulnerable citizens—Medicare beneficiaries who need intensive therapy services as a result of stroke or other illness or disability.
Joanne Wisely, a speech-language pathologist and manager of regulatory compliance at Genesis Rehabilitation Services in Kennett Square, PA, recalls the “confusion and frustration” she felt when the cap first went into effect in 1999, when she provided direct care.
“We didn’t know how much or how long we were going to be able to treat our patients. And the worst thing was that the sickest patients were hardest hit,” she said.
Susan Chapman, a clinical specialist at Genesis who lives in the small town of Elon, NC, has bad memories from 1999, when she provided services to Part B beneficiaries in long-term care facilities. She dreads the thought of the cap’s possible return.
“Under the cap, the burden of care shifts onto the patient, the caregivers, and the providers,” she said. “It forces decisions to be made about a person’s quality of care based upon money alone.”
Stroke victims in particular feel the harsh impact of the therapy caps. According to the National Stroke Association, 750,000 Americans suffer strokes each year, and many are of Medicare age. Stroke victims often need intensive outpatient therapy services, and this cut in benefits could mean they might not regain maximum function.
“They need to focus on healing and compensating for their losses, and shouldn’t have to worry about whether they’re going to exceed the cap,” Chapman said.
The combined cap that provides only $1,500 annually for both speech-language pathology and physical therapy services brings additional burdens. For stroke victims and others who need both services, the cap forces them to choose between communication and mobility—both of which are crucial to quality of life.
Since SLPs also provide dysphagia services for swallowing disorders, those services also could be curtailed.
Added Chapman, “So, do they walk or do they eat? If they cannot swallow safely and maintain nutrition, this will affect their ability to ambulate. For clinicians, it’s a horrible ethical position to have to be in.”
Legislative Pitfalls
On Capitol Hill, the two-year moratorium included in H.R. 4954 was a victory for ASHA and other advocates who had expected no more than a one-year extension. Less than a day before committee consideration of the bill, the Republican leadership conceded to pressure from advocates and moved some of the money set aside for the prescription drug program back into the main portion of the Medicare program. This allowed them to include the two-year extension of the moratorium.
A one-year extension would have “left us with problems” that had to do with political timing, noted Larry Higdon, ASHA’s vice president for governmental and social policies.
If a Medicare bill passes this year, chances are slim that another Medicare bill would move next year. A one-year extension would expire in a legislative drought, leaving clinicians and beneficiaries high and dry.
“A one-year extension would have been better than nothing, but we would have had a heck of a fight on our hands next year,” Higdon said. However, he added, “Our goal has been, and continues to be, to completely abolish the $1,500 cap. We need continued support from members and their representatives to achieve that end.”
ASHA President Nancy Creaghead described the two-year extension as “a very dramatic turnaround.”
“Within a few weeks, we went through three scenarios,” she said. “First we thought the bill would re-impose the cap, then that we would get a one-year extension—which would help, but cause big problems next year—and finally, we are seeing a two-year extension of the moratorium.”
But H.R. 4954 faces political land mines this midterm election year. Partisan conflicts have already erupted over the prescription drug benefit in the Medicare bill. And Democrats and health care provider groups have charged that the bill privatizes Medicare and denies care to patients.
As a result, the bill could easily stall in the Democrat-controlled Senate, where ASHA plans to launch an aggressive campaign to include the two-year extension in its version of the bill.
“It is vital that members become engaged and active on this issue. We need to take every opportunity to remind Congress that they need to deal with the cap this year,” Creaghead said.
If the House and Senate come up with differences they cannot resolve in a compromise bill, Congress could adjourn without passing Medicare legislation.
If that happens, the cap is back. And this time its effects could be even worse, Chapman said.
“We’re providing more outpatient services now because people are living more independently, at home,” she said. “Cuts in therapy benefits may force beneficiaries to move to a setting that requires more caregiver support, thus compromising their dignity and increasing the burden of care. That’s an unacceptable outcome.”
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July 2002
Volume 7, Issue 13