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Once We’re Dug Out
February 11, 2010 • Volume 10, Issue 6
Back-to-back blizzards have frozen progress this week on a jobs bill that will likely include important provisions for people with Medicare.
When the roads are plowed and Congress returns to work, it is critical that lawmakers pass this legislation as soon as possible. The legislation’s main goals—getting Americans back to work and extending unemployment assistance and help to pay health insurance premiums for those who still can’t find work—are urgent, and two Medicare provisions are critical for older adults and people with disabilities to maintain access to their health care.
The Senate jobs bill circulated this week would prevent a 21 percent Medicare pay cut for doctors from taking effect on March 1. A pay cut this drastic could seriously harm the ability of people with Medicare to maintain relationships with their doctors. This provision is a stop-gap measure—it delays the cut, which is mandated under the current Medicare payment formula, until October—and does not change the formula for the long term. That change, which is necessary to avert a series of annual pay cuts required under current law, will have to wait for passage of additional legislation.
The second key provision in the Senate jobs bill would reinstate a policy allowing exceptions to an annual cap on outpatient rehabilitation therapy for people with Medicare. The exceptions policy expired at the end of 2009, which means that people with Medicare who need extensive therapy—to recover from a stroke, for example, or for treatment of Parkinson’s disease—could be denied coverage for the full course of therapy they need. Many people with Medicare are now hitting the $1,860 cap; the sooner Congress reinstates the exceptions policy, the sooner these people can receive coverage for their treatments.
The House jobs bill passed in December does not include these Medicare provisions, but there is strong support in the House for dealing with both the therapy cap and the doctor payment issues. (The House passed a permanent repeal of the Medicare doctor payment formula last year. Both the House and Senate health reform bills extended the exceptions policy for rehabilitation therapy.)
People with Medicare have a lot staked on prompt passage of legislation that puts off the doctor pay cut slated for March 1 and allows exceptions for people who need rehabilitation therapy above the cap. Lawmakers should not seek to delay or derail this legislation to score political points.
“The Senate bill could also include a short-term patch to Medicare's physician payment formula, which must be adjusted in order to avoid steep decreases in Medicare reimbursements to doctors. If the formula remains unchanged, the payment rate would drop by roughly 21% in March.” (Jobs Bill Likely to be Delayed in Senate, Wall Street Journal, February 2010)
“Effective January 1 of this year, people with Medicare face a $1,860 cap on the amount of physical and speech therapy they can receive during the year, as well as a separate $1,860 cap on occupational therapy. The therapy caps limit treatment for older adults and people with disabilities who need extensive therapy as they recover from a stroke or other acute episode, or suffer from chronic conditions such as Parkinson’s disease or multiple sclerosis.” (Congress Must Extend Exceptions to Medicare Therapy Cap, Medicare Rights Center, February 2010)
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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