For Medicare beneficiaries and providers, it has been a challenging start to 2010. The first session of the 111th Congress adjourned in late December without finalizing decisions on the Medicare Part B therapy cap and related Medicare extenders, without finishing healthcare reform, and with punting decisions on Medicare professional fee schedules into February. Following two months of partisan wrangling, limited progress has been made on these same issues. As discussed below, a stop-gap measure clarifies the therapy cap exceptions process and fee schedule issues through the end of March 2010 and there are signs that final Congressional action on healthcare reform is possible.
Medicare Therapy Cap Exceptions Process/Fee Schedule:
On March 2, the Senate reached agreement to consider and enact H.R. 4691, the Temporary Extension Act. On the same day, the enactment was signed into law by President Obama. The legislation which extended a series of government programs through March 31, 2010 including funding for unemployment and COBRA benefits, protections against a 21%+ reduction in Medicare professional fee schedules, and corrective actions to reinstate the Medicare Part B therapy cap exceptions process.
The final provisions retroactively reinstating the Medicare Part B therapy cap exceptions process through March 31, 2010, and the provision maintaining the Medicare professional services fee schedule conversion factor at the 2009 rate through the end of March, 2010. This latter action prevented the scheduled formula driven 21.5% payment reduction for physician and non-physician services from going into effect. The enactment provides very short-gap relief only to the end of March. Both the Senate and the House of Representatives are scheduled to recess in late March for the Passover/Easter recess. This leaves open the potential of another “crisis.”
HeathCare Reform:
Events of the past three weeks have moved Congressional consideration of healthcare reform back to center stage. On February 25, President Obama convened a “bi-partisan healthcare summit” with key Congressional leaders from both parties. Just prior to the meeting, the White House released a healthcare reform discussion draft that pretty much followed the Senate-passed version of the legislation. The forum provided the President the media limelight which he capitalized on with a strong emphasis on pushing for “an up or down vote.” Post-summit, the President acknowledged several of the ideas that were advanced by Republican leaders, and he proposed inclusion of those technical points in the final legislation.
The President’s emphasis on an “up or down vote” is code for the Congress to use its authority to consider healthcare reform using the special rules for considering budget legislation. Last spring, both the House and the Senate agreed as part of the FY10 First Budget Resolution to authorize the use of the special budget rules for healthcare reform. While the use of “reconciliation” is only a procedural issue in the House of Representatives, it is a major different in the process for Senate consideration as the budget rules limit debate, prohibit filibusters, and mandate a simple majority threshold for passage (normal Senate procedures require 60-votes to bring closure). There are certain procedural restrictions limiting the types of provisions that can be considered under reconciliation (so-called Bryd Rules). Expect that over the course of the coming weeks, there will be extended discussions on what can and cannot be considered during these parliamentary rules.
The President is pressing for quick action; he has urged Congressional leaders to enact the legislation before leaving for the Passover/Easter recess. It is highly doubtful that target date will be met. For one, the actual legislative text of what the President wants is still being drafted, and once drafted needs to be scored by the Congressional Budget Office. It will be the middle of March at the earliest before those steps will be completed. But perhaps more important is conflict within Congress on how to proceed. Senate leaders are urging the House of Representatives to enact the Senate-passed version of healthcare reform, and, then, to draft and enact a corrective package of legislation using the budget reconciliation process to address items in dispute. This approach would give the President a Congressional approved version of healthcare reform to sign into law avoiding the potential of a “closure vote” in the Senate. It is highly doubtful that Speaker Pelosi could get sufficient votes to pass the Senate version (issues such as abortion coverage and individual mandates are extremely controversial in the House). Speaker Pelosi wants the Senate to enact corrective revisions using the budget reconciliation process which would then give House members comfort that required revisions will be made. In short, the “what’s next” will stretch into mid-spring; final resolution is not imminent.
Need for Continued Grassroots Advocacy:
The final outcome of these Congressional debates on Medicare policies and healthcare reform will define the parameters of access, coverage and payment for professional therapy services. While it is easy to “tune out” what happens in Washington, D.C., the reality is absent our continued involvement “wrong decisions” can be made. As advocates for our patients/residents and our professionals, we must take the time to stay engaged and to communicate our concerns to our elected officials. Policy making is a process, not an event; there is need for our sustained involvement and attention.
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