Larry's Corner

This year began with wide spread optimism that with the help of the incoming Obama Administration and newly elected Congress progress would be made on policy issues affecting access to and payment for rehabilitation services. Even by mid-year there were signs that actions would be taken to sustain stability in payments under the RBRVS physician and non-physician fee schedules, to provide short-term administrative actions in developing alternatives to the Medicare Part B therapy caps, and confidence that rehabilitation services would receive favorable treatment as part of healthcare reform.

 

Unfortunately, as we enter the last month of the year, limited progress has been made in achieving any of these initiatives.

 

What is clear is that Congress will not complete consideration of healthcare reform legislation this year. While the House of Representatives has passed its comprehensive package, and the Senate debate is underway, there are just not enough legislative days to finalize actions in the U.S. Senate and then work through the numerous differences in the House-passed and potential Senate-finalized measures. At best, final Congressional action will slide into 2010. Thus, healthcare reform as the vehicle for addressing expiring provisions of current Medicare law related to the fee schedules and therapy cap exceptions process will get resolved too late to prevent a disruption of beneficiary services. Embedded in both the House-passed and Senate pending healthcare reform legislation are provisions extending the Medicare Part B therapy cap exceptions process [Section 1231 of H.R. 3962- House-passed; Section 3103 of H.R. 3590 Senate-substitute].

 

With regards to safeguarding the physician/non-physician fee schedules, the House of Representatives has passed legislation separate from healthcare reform to revise the payment formula under the RBRVS (Resource Based Relative Value Scale). Designed to decouple the payment formula from the larger healthcare reform package, this legislation (H.R. 3961) has stalled in the Senate, essentially blocked by Senate consideration of healthcare reform.   

 

Last-ditched efforts are underway to secure short-term relief to both stabilize the Part B fee schedules and to extend the Medicare Part B therapy cap exceptions process. Favorable discussions are underway with key Congressional leaders who are attempting to craft an “omnibus” package addressing a range of issues back-logged because of extended Congressional deliberations. Between now and the end of December, Congress must act to continue Federal funding for a number of government agencies – or confront a shut down of essential services; Congress must act to extend and increase Federal borrowing authority – or confront Federal default; and Congress must consider an array of expiring taxation and Medicare statutes.

 

Now is the time to make our case. We must collectively raise our voices advocating on behalf of our clients and professions for the Congress to provide interim relief on important rehabilitation issues until final decisions are made on healthcare reform. Working closely with the National Association for the Support of Long Term Care (NASL) and the Washington Rehabilitation Caucus (WRC), Genesis Rehabilitation Services (GRS) has facilitated access to a “Cap Wiz” e-mail letter system that makes communicating with your elected officials quick and easy. This call to action can be accessed on both Genesis Rehab and Genesis Central. Legislators will understand the need for quick action, the more communications that are sent to them.

 

 It is nail biting time for Medicare rehabilitation services. Our collective actions can help overcome this unexpected, unfortunate, uncertainty!