Health Care Reform Updates -
Breaking New Developments
June 25, 2010
President Obama Signs Temporary Medicare Physician Payment Fix
On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. CMS expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.
Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor.
The Academy will continue to strongly advocate for repeal of the Medicare Sustainable Growth Rate (SGR) formula and has conducted several member Calls-to-Action on this issue. Please continue to log on to the Academy’s website for timely updates on this important issue.
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June 21, 2010
Senate Approves Six-Month Medicare SGR Fix
On June 18, the Senate passed an amended version of H.R. 3962, now called the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010,” by unanimous consent. This legislation provides a 2.2 percent Medicare physician payment update for six months, from June 1 through November 30, 2010, in lieu of the scheduled 21 percent cut. … read more
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June 17, 2010
Academy Signs on Unified Statement of State and Specialty Delegations to the AMA House of Delegates
The Academy continues to strongly advocate for repeal of the Medicare SGR formula and has repeatedly called for Congress to implement a new Medicare physician payment update mechanism that guarantees access to quality care for seniors and people with disabilities and that accurately reflects the increasing annual costs of providing services to Medicare beneficiaries. Congress has yet to act on legislation to stop the June 1, 2010 21 percent Medicare physician payment cut, threatening their access to care for beneficiaries.
At the recent AMA Annual Meeting, there was debate in the AMA House of Delegates on this issue. Subsequently, state and specialty delegations, including the AAPM&R, signed on a unified statement on the state of affairs. The statement was distributed to all members of the AMA HOD and urges Congress to "honor its obligation to provide access to quality care to America’s seniors and military families by taking action to fix the Medicare physician formula problem now!"
Click here to read the statement. (PDF Download)
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June 17, 2010
CMS Message to Physicians
The following message from CMS indicates that the Medicare contractors have been instructed to hold claims for services provided in June for an additional three business days. This means that unless Congress sends legislation averting the cut to President Obama for signature within the next few days, carriers will begin processing claims with the 21% cut on Friday, June 18th. CMS acknowledges in this message that the additional delay could pose cash flow problems for some physicians.
The choice between not getting paid from Medicare at all or getting paid 79% of current rates places physicians between a rock and a hard place with no good options. If Congress fails to act before Friday, then carriers will start processing June claims at the reduced rates and, whenever Congress does act, these claims will need to be reprocessed and retroactively adjusted. There is only one truly good option and that is for Congress to repeal the formula that produces these cuts. To contact your Senators and urge them to act quickly, click here and participate in the Academy’s Call to Action on the Medicare SGR.
To read the CMS Message to Physicians, click here.
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June 8, 2010
Stop the Medicare Meltdown Petition
AAPM&R Joins National Effort to Stop the Medicare Meltdown – The Academy has joined with more than 50 state and national medical societies seeking a permanent fix to Medicare's SGR payment formula. A nationwide effort is currently underway to gather signatures on a petition asking Congress to "Stop the Medicare Meltdown". In addition to the signatures, the medical societies are listed on the petition as supporters of the effort.
How can YOU help? Click on the link below and sign the petition and ask your colleagues to sign it TODAY. http://www.ipetitions.com/petition/meltdown
The Stop the Medicare Meltdown campaign is planned through the August Congressional recess when a media event is planned and physicians will be asked to contact their members of Congress in their various congressional districts during that recess. More information will be posted when it becomes available.
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May 28, 2010
Update on the Medicare SGR Formula
Participate in the New Academy "Call-to-Action" on this Issue
On May 28, the House passed an amended version of H.R. 4213, the "American Jobs and Closing Tax Loopholes Act of 2010," which includes provisions to suspend Medicare physician payment cuts produced by the sustainable growth rate (SGR) formula for 19 months. In lieu of the 21 percent cut originally scheduled for 2010, the House-passed proposal would implement a 2.2 percent payment update for the remainder of this year, and a 1 percent payment update for 2011. In 2012, the SGR formula will resume, with an estimated 33 percent payment cut taking effect that year.
The SGR provisions were voted on separately from the rest of the legislation, passing on a bipartisan vote of 245 to 171. To see how your Representative voted, visit http://clerk.house.gov/evs/2010/roll325.xml.
Because the Senate is adjourning for the week-long Memorial Day Recess, it will not vote on the legislation until after it returns on June 7. As was previously the case, the Centers for Medicare & Medicaid Services has instructed its carriers to hold Medicare claims for services provided on or after June 1 for 10 business days, until June 14, which should provide sufficient time for Congress to stop implementation of the cut retroactively.
Members are asked to participate in the Academy’s June 1, 2010 Medicare SGR "Call-to-Action" and contact their U.S. Senators and urge them to repeal the Medicare SGR. To participate in this important grassroots campaign and let your voice be heard, go to the Advocacy Action Center at: http://www.aapmr.org/hpl/legislation/adv_action_ctr.htm
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May 21, 2010
Health Care Reform Law Analysis
Read the legal analysis of the Patient Protection and Affordable Care (Pub. L. No. 111–148) and the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111–152). The document is written primarily from the health provider and consumer perspective and summarizes key provisions of the new law which is nearly 1,000 single-spaced pages.
To read the analysis, click here. (PDF Download)
AAPM&R Chart of Health Reform Priorities (PDF Download)
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April 21, 2010
Academy Advocates for $75M Provision for Quality Measures
National Advocacy on Health Reform Law Provision
Your Academy joined a group of over 30 medical specialty societies and sent a letter to the House and Senate Appropriations Committees to ensure the authorization of $75 million for FY 2011 to identify gaps in quality measurement and develop patient-centered measures to fill those gaps, as included in the recently enacted health care reform law, is actually funded. These monies will allow the Secretary of the Department of Health and Human Services to provide grants to eligible entities to develop and update quality measures to address specific health care populations and priorities.
Quality measures are critical tools for various healthcare professions. These measures are needed to meaningfully improve the quality of health care and to ensure that they can be maintained over time as evidence and technology evolve. Because quality measurement affects all stakeholders across the continuum of health care, federal funding of measure development and testing is essential.
To read the letter, click here. (PDF Download)
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April 16, 2010
President Signs Bill that Includes a Temporary Fix for the
Medicare SGR
On April 15, President Obama signed H.R. 4851, the Continuing Extension Act of 2010, into law, reinstating Medicare physician payments to where they were on March 31 and again postponing the 21.3 percent cut that was supposed to take effect in 2010. This most recent extension of 2009 payment rates will continue through the end of May, 2010 and will be applied retroactively to all physician services provided to Medicare patients in April. The legislation passed the Senate at about 5:45 PM on April 15 by a bipartisan vote of 59-38, and subsequently passed the House shortly after 8:00 PM by a bipartisan vote of 289-112.
Important Information from CMS on Claims Processing
The new law extends the zero percent update to the Medicare Physician Fee Schedule (MPFS) that was in effect for claims with dates of service January 1, 2010 through March 31, 2010. The law is retroactive to April 1, 2010. Consequently, effective immediately, claims with dates of service April 1 and later, which were being held by Medicare contractors, are being released for processing and payment. Please keep in mind that the statutory payment floors still apply and, therefore, clean electronic claims cannot be paid before 14 calendar days after the date they are received by Medicare contractors (29 calendar days for clean paper claims).
Given the uncertainty regarding MPFS claims with dates of service June 1, 2010, and later, please monitor your contractor’s website for more information.
The Academy would like to thank members who participated in the March 31 and April 12 "Calls-to-Action" on this issue. We value your efforts to advocate on behalf of the specialty, your practice, and your patients. The Academy will continue to work closely with the AMA and other medical specialties, advocating for a long-term solution to the Sustainable Growth Rate formula and will update you on these efforts soon.
To see how your member of the U.S. Senate voted, click here.
To see how your member of the U.S. House voted, click here.
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March 31, 2010
New Health Reform Law Extends Medicare Outpatient Therapy Cap Exceptions Process
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act, which extends the exceptions process for outpatient therapy caps (see Section 3103). Outpatient therapy service providers may continue to submit claims with the KX modifier, when an exception is appropriate, for services furnished on or after January 1, 2010, through December 31, 2010. The Academy is continuing to advocate for full repeal of the caps or a permanent extension of the exceptions process.
For more information, go to the CMS Web site at: www.cms.gov/TherapyServices
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March 31, 2010
President Obama Signs Historic Health Care Reform Legislation
On March 23, President Obama signed historic legislation, the Patient Protection and Affordable Care Act (H.R. 3590) into law to reform the nation’s health care system and on March 30, he signed the Health Care and Education Affordability Reconciliation Act (H.R. 4872) which contains refinements and amendments to the comprehensive health reform bill and was intended to bridge some of the differences between the original House and Senate final health reform bills. According to the Congressional Budget Office (CBO), the final health care reform package—the Senate bill (H.R. 3590) and the reconciliation bill could cost $938 billion over 10 years, provide coverage for about 32 million more Americans and includes major provisions on health system reform.
AAPM&R Position on Health Reform
Throughout the months of heightened advocacy around health reform legislation, the Academy’s position reflected the specialty’s values, mission statement, and core purpose. Due to the diversity of PM&R practice and the fact that comprehensive health reform legislation addressed many issues such as taxes, abortion and immigration that were outside the scope of the Academy’s organizational mission, and were not central to PM&R, our focus was to continue to strongly advocate and represent the concerns of our members and our patient community.
Current AAPM&R Health Reform Activities
Your Academy is working on a preliminary analysis of the law to determine how the bill may impact physiatrists; once completed, the analysis will be posted to the Academy Web site. The Academy’s Health Policy and Legislation (HP&L) Committee has appointed a Final Rule Subcommittee to address the Department of Health and Human Services’ (HHS) and other federal agencies’ regulations emanating from the new health reform law as the agencies begin the regulatory phase of this process. The subcommittee has begun collecting information on the prospective rulemaking process regarding the new health reform law. Please continue to monitor the Academy’s Web site for updated information on the implementation of the new health reform law.
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March 22, 2010
House Passes Historic Health Care Reform Legislation
On March 21, the House Democrats passed historic legislation, H.R. 3590, the Patient Protection and Affordable Care Act to reform the nation's health care system. The bill provides $875 billion over the next decade to expand insurance coverage to an estimated 32 million people. The House also passed the reconciliation bill, H.R. 4872, the Health Care and Education Affordability Reconciliation Act, which contains additional refinements. The two bills comprise the most important health care legislation since the creation of the Medicare program in 1965. President Obama is expected to sign the bill on March 23. Academy staff is working on an analysis of the bill and will update members later this week with details about how the bill may impact physiatrists.
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March 22, 2010
Bill on the Medicare SGR Expected This Spring
The Academy and other national medical societies are continuing advocacy for congressional action to permanently repeal the Medicare sustainable growth rate (SGR) formula. This issue was removed from health system reform legislation and it is possible that House and Senate leaders will bring SGR legislation for a vote this spring.
Earlier this month, the Academy sent a letter to House and Senate leaders urging “that any health reform bill: 1) fixes the impending 21 percent cut in FY 2010 by repealing the Medicare Sustainable Growth Rate (SGR) formula, and 2) either completely repeal the current therapy caps policy or permanently extend the related exceptions process. Both are temporary policies that must be resolved once and for all so that we can guarantee access to quality care for seniors and people with disabilities”.
To read the letter, click here. (PDF Download)
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March 15, 2010
Academy Submits Letter to CMS on the EHR Incentive Program
Your Academy sent comments to CMS’ Acting Administrator on the FY 2010 Proposed Rule for Implementing the Medicare and Medicaid EHR Incentive Programs. Overall, the Academy supports the program as an essential tool to improve patient care, enhance patient safety and improve efficiency but is concerned that the proposed rule is too aggressive and, unless modified, may impede the development of meaningful use of EHR. Specifically, the Academy is concerned that many of the proposed program criteria will not be achievable for most physiatric practices.
To read the letter, click here. (PDF Download)
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March 10, 2010
Academy Signs on AMA Letter on EHR "Meaningful Use" Incentive Program
The Academy, along with the AMA and other medical national societies, signed on a letter to the Centers for Medicare and Medicaid Services (CMS) on the proposed rule for implementing the electronic health record (EHR) incentive programs. While the letter is supportive of CMS' efforts, the organizations want to ensure that there is widespread adoption and "meaningful use" of EHRs by physicians and offers suggestions to improve the proposed rule. Physicians with approved EHRs in place before 2012 will be eligible for the maximum Medicare incentive payments allowed by the American Recovery and Reinvestment Act of 2009. Physicians who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.
To read the letter, click here. (PDF Download)
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March 10, 2010
Academy Urges House and Senate Leaders to Consider its Recommendations in Final Health Reform Legislation
Your Academy sent a letter to the Speaker of the House, Nancy Pelosi and to Majority Leader, U.S. Senate, Harry Reid offering our recommendations on a number of proposals in the House and Senate bills over the course of their final agreements on health care reform legislation. The letter strongly asserts that any health reform bill fixes the impending 21 percent cut in FY 2010 by repealing to Medicare Sustainable Growth Rate (SGR) formula and completely repeal the current therapy cap's policy or permanently extend the related exceptions process. In addition, the letter includes recommendations for reforms in the insurance market, investment in research and the Medicare program.
To read the letter, click here. (PDF Download)
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March 4, 2010
President Signs a Bill for a Temporary Extension to the Therapy Cap Exceptions Process Updated 3/12/10
The Academy's advocacy efforts around the Medicare outpatient therapy cap resulted in a temporary victory as the president signed The Temporary Extension Act of 2010 on March 2. The new law includes a temporary extension to the exceptions process of the cap. The new law extends through March 31, 2010, the exception process for therapy claims reaching the annual cap, retroactive to January 1, 2010. Affected providers may submit claims for exceptions to the annual therapy caps, with dates of service January 1 through March 31, 2010, using the KX modifier, following the pre-January 1, 2010, requirements for therapy cap exceptions.
At the time of this writing, the Senate passed H.R. 4213, a bill that would extend the exceptions process until December 31, 2010. However, this legislation will now be sent to the House, where amendments are possible. Consequently, it is not certain if this extension of the exceptions process can be signed into law before the current extension expires on April 1.
Medicare Outpatient Therapy Cap: Temporary Extension
The new March 2, 2010 law (The Temporary Extension Act of 2010) signed by President Obama also includes a temporary extension for the Medicare outpatient therapy cap. The new law extends through March 31, 2010, the exception process for therapy claims reaching the annual cap, retroactive to January 1, 2010. Affected providers may submit claims for exceptions to the annual therapy caps, with dates of service January 1 through March 31, 2010, using the KX modifier, following the pre-January 1, 2010, requirements for therapy cap exceptions.
Your Academy, along with 34 organizations that represent patients and other health care professionals that receive or provide outpatient rehabilitation services to seniors and individuals with disabilities under Medicare, signed on a letter to Speaker Nancy Pelosi requesting immediate action to pass legislation to address the expiring outpatient therapy caps' provisions under Medicare.
To read the letter, click here. (PDF Download)
To read the Academy's position on the therapy cap, click here.  (PDF Download)
To read a sign-on letter on this issue, click here. (PDF Download)
To read coalition-driven letters, click here. (PDF Download)
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March 3, 2010
President Signs Bill on Medicare Payment Cuts Postponed
for 31 Days
Late in the evening on March 2, President Obama signed H.R. 4691, the "Temporary Extension Act of 2010," which included provisions to extend 2009 Medicare physician payment rates through the end of the month. As a result, the 21% payment cut that took effect on March 1 has been postponed until April 1.
The President received the bill after last night's passage in the Senate by a vote of 78–19. The Senate was able to move forward with the bill when Senator Jim Bunning (R-KY) withdrew his objection to the legislation.
The bill passed the House on February 25, and was opposed on the Senate floor by Senator Jim Bunning (R-KY), who objected to the legislation being considered as an emergency measure that would not require budgetary offsets. In addition to postponing Medicare physician payment cuts, the bill extended a variety of other expiring programs including unemployment insurance and premium subsidies for COBRA continuation coverage for those whose employment was involuntarily terminated.
Discussions are still underway in the House and Senate on the next steps that will be taken to address the Medicare payment crisis. Proposals are being circulated that would implement still another short-term patch to the sustainable growth rate (SGR) formula, including proposals that would postpone cuts for 90 days, 7 months, or through the end of 2010.
The Academy will continue to press for physician payment reform that does not limit patient access and meets the costs of maintaining a medical practice. This would include such measures as repealing the SGR formula which threatens access to care for seniors and people with disabilities.
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March 1, 2010
Physician Payment Cut To Go Into Effect; Lawmakers Talk of Delaying Cut After Deadline Passes
On Monday, March 1, a 21 percent cut to Medicare physician payments is scheduled to go into effect. The cut was initially scheduled for implementation at the beginning of the year, but was temporarily delayed through legislation. Now Democratic leaders are talking about extending that delay later this month, despite having passed the deadline for implementation.
Toward the end of February, Majority Leader Harry Reid (D-NV) tried to gather support for unanimous consent to pass an "extenders" package through the Senate, but Republicans objected to the bill because it does not include pay fors. Despite the Senate's pay-as-you-go rules, the bill was given emergency status so that its provisions are not coupled with offsets.
The legislation would have delayed the physicians payment cut for another month, and also included an extension for unemployment benefits and an extension for the Medicare outpatient therapy caps exceptions process.
The Academy has been informed that the Centers for Medicare and Medicaid Services (CMS) will be notifying their contractors to hold Medicare physician claims for 10 business days, effective March 1. CMS will also be sending out a similar message on its various listservs to physicians, and contractors who will be instructed to disseminate this information as well.
The Academy strongly advocated for physician payment reform that does not limit patient access and meets the costs of maintaining a medical practice through such measures as repealing the Medicare Sustainable Growth Rate (SGR) formula which threatens access to care for seniors and people with disabilities.
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February 25, 2010
White House Holds Health Care Summit and Releases Outline of Legislative Proposal
The White House hosted a bipartisan health care reform summit and released an overview of a legislative proposal that mainly follows the already passed Senate legislation but offers some compromises between the House and Senate bills. Lawmakers from each party joined President Obama for a day long discussion on health care reform, where the President pushed Republicans to make suggested changes for the current bills so that they could support reform, and Republicans pushed back asking the White House to scrap the legislation and begin again with a less costly and controversial bill.
But neither the White House nor Congressional Democratic Leaders have signaled that they will start over. To the contrary, parts of Obama's recent proposal could be used as an outline for an amendments package to pass through reconciliation in the Senate. This simple majority procedure has been a lightening rod for controversy, with Republicans arguing that it is a way to block them out of the debate. If the Senate were to pass the amendments package, the House could take up the amendments package with the Senate bill and pass both simultaneously.
However, it is unclear how much support President Obama's proposed compromises have in the House, and Democratic Representatives could fight for further changes before agreeing to pass the Senate bill. Whether or not Democratic lawmakers adopt the President's proposal as legislation still remains to be seen. Senate Majority Leader Harry Reid (D-NV) has set a new completion deadline for Easter recess; President Obama had hoped to sign health care reform legislation by the end of last year.
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January 27, 2010
Academy Advocacy Around Health Care Reform
Over a year ago, the Academy began an advocacy campaign around national health reform legislation that impacted our specialty and our patients. It is critical that members remain involved in this process. Learn more about the Academy's health care reform advocacy efforts here.
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January 19, 2010
Massachusetts Elects a New Senator:
Immediate Changes Under Way on Health Care Reform Legislative Strategy
In a January 19 Massachusetts special election, the Republican candidate, Scott Brown, won by a close vote to replace the Senate seat left vacant by the deceased Democratic Senator Ted Kennedy.
Plans to send a revised version of the health care bill for further votes have come to a screeching halt, as it is not expected that after Brown is seated, Democrats would be able to avoid a filibuster in the Senate.
To read more, click here. (PDF Download)
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January 15, 2010
Therapy Caps Exceptions Process Expires
Outpatient therapy caps are currently in effect for 2010 and the exceptions process which has been in effect for several years expired December 31, 2009 and thus is not currently in effect. Although provisions in the House and the Senate health care reform bills would extend the exceptions process, Academy members should be aware that as of January 1, 2010 there is no exception to the therapy cap.
The cap for 2010 is $1860 for physical therapy and speech language therapy combined, and $1,860 for occupational therapy. The cap applies to therapy services provided in all outpatient settings except for hospital outpatient departments. We believe it likely that the exceptions process will be extended in the final health care reform legislation which is likely to pass in the next several weeks. In the meantime, and until that happens, you should be aware that therapy charges in excess of $1,860 will not be covered by Medicare and there is no exceptions process currently in place.
On Dec. 15, the Academy signed on a coalition letter to Speaker Pelosi requesting immediate action to pass legislation to address the expiring Medicare outpatient therapy caps. In addition, we sent a letter to Speaker Pelosi and Majority Leader Reid urging them to either completely repeal the current therapy caps or permanently extend the related exceptions process in the final health reform bill.
Your Academy will continue to proactively advocate on this issue and will provide updates as we receive them on our Web site.
More information about the therapy cap can be found on the CMS website at www.cms.hhs.gov/Transmittals/downloads/R1860CP.pdf. (PDF Download)
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January 14, 2010
Academy Prepares for Next Steps on Health Reform Legislation
Continuing our efforts to advocate for PM&R issues in the final health reform legislation, your Academy sent a letter to the House and Senate conferees who are currently deciding on a final health reform bill to send to the president. When members reconvened, a task of monolithic proportion awaited them—to begin the history-making charge of reconciling two bills and thousands of pages, each using a “ping pong” approach to agree on a final bill. Most of the committee's work will happen behind closed doors, so the Academy wasted no time in getting to the House and Senate leaders that highlights the talking points of our position on national health reform.
Read the letter to the House and Senate, click here. (PDF Download)
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