Health Care Reform Hotline -
Breaking New Developments
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.
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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.
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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.
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December 18, 2009
Academy Supports Amendment that Would Increase GME Positions
Prior to the final vote on the Senate health care reform bill, your Academy wrote to key U.S. Senators expressing our support for an amendment to the bill that would increase the number of graduate medical education positions by 15 percent. Since 1997, the nation’s physician training capacity has been static and now there is mounting evidence that our nation faces a significant shortage of physicians in primary care, general surgery, as well as many specialties, while the population continues to grow and age placing unprecedented demands on the health care system.
If enacted in the final health care reform legislation, the provision will enhance the nation’s ability to meet future physician workforce needs.
The Academy worked quickly in the final days before the Senate passed its health care reform bill on December 24 to advocate for support of the amendment. In the letter, we highlighted the fact, that with so much emphasis on health insurance coverage—it was essential to remind lawmakers that coverage does not equal access and that we must educate and train a cadre of physicians capable of meeting the health care needs of our growing and aging population, with priority given to those specialties and subspecialties—including primary care and general surgery—that are facing shortages and are most needed.
To read the Academy’s letter, click here.
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December 15, 2009
Academy Signs on Letter to Speaker Pelosi on the Medicare Outpatient Therapy Caps
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.
Of critical importance is the expiration of the clinically-based exceptions process that ensures access to outpatient rehabilitation therapy services provided by qualified providers. These therapy caps must be addressed by Congressional leadership. The Academy was disappointed to learn of the lack of action by Congress on this issue, especially given the opportunity for lawmakers to attach a temporary extension to the caps exceptions process to the Department of Defense Authorization Act that was signed by President Obama. We will continue to press congressional leaders for an extension to the exceptions process and moreover, for the elimination of the arbitrary caps.
To read the letter, click here.
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December 14, 2009
Academy Participates in National Campaign for Permanent Repeal of the Medicare SGR Formula
Academy signed on a letter along with the AMA many other national medical societies asking Congress to establish a pathway toward permanent repeal of the SGR. With a 21.2% Medicare payment cut scheduled to take effect soon, there have been reports of various options for addressing the problem being discussed on Capitol Hill. The medical societies strongly believe that another “routine” short-term payment fix is not in the best interest of physicians or their patients and it is time to enact a permanent SGR repeal. The Academy also supported the House of Representatives-passed legislation in November that offers a pathway to permanent repeal of the SGR formula.
To read the letter, click here
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November 13, 2009
Academy Supports House Physician Payment Bill
Your Academy sent a letter to House Speaker Nancy Pelosi expressing support for the Medicare Physician Payment Reform Act. H.R. 3961 would avert the 21 percent physician payment cut and permanently replace the method used to calculate physician payment—the Sustainable Growth Rate (SGR) formula, with a mechanism that should better measure growth and allow appropriate annual Medicare updates. The letter stressed that “such a substantial cut in physician reimbursement could impact access and quality care for our patients who comprise the most vulnerable patients.” All physicians are facing the 21 percent payment cut in Medicare Part B physician payments scheduled for 2010 because of the flawed SGR formula and many national physicians’ societies are supporting this measure. The House is expected to act on the bill this week.
To read the Academy’s letter, click here
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November 11, 2009
House of Representatives: Physician Payment Fix Legislation
The House will debate the Medicare Physician Payment Reform Act (H.R. 3961). The bill would prevent pending Medicare physician fee cuts and codify PAYGO offset requirements. In October, the Senate failed to bring to the floor a similar bill.
The Congressional Budget Office estimated that H.R. 3961 would cost $210 billion over ten years and stated that the cost of the bill's payments to physicians, Medicare Advantage and TRICARE would be partially offset by $49 billion in Part B premiums.
H.R.3961 would repeal the looming 21.2 percent Medicare payment rate reduction for physician services in 2010 and replace the formula with a new payment mechanism for future cuts.
House leadership could eventually re-attach the fix to the House healthcare reform bill, leaving its fate to the healthcare reform conference negotiations.
For more information on H.R. 3961, click here. 
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November 7, 2009
House Passes Landmark Health Reform Legislation
With a narrow vote of 220-215, on November 7, the House passed the more than $1 trillion Affordable Health Care for America Act (H.R. 3962). Thirty-nine House Democrats did not vote for the bill and one Republican, Representative Anh Cao of Louisiana, voted for it.
Briefly, the nearly 2,000-page House bill would require:
- Most Americans to obtain health insurance;
- A National Health Insurance Exchange through which individuals and employers could purchase qualified insurance;
- A tax on individuals without acceptable health care coverage subject to certain circumstances;
- Most employers would to provide coverage or pay a tax penalty of up to 8 percent of their payroll;
- An essential benefits package with comprehensive services subject to certain conditions;
- Would significantly expand Medicaid to all individuals under age 65 with incomes up to 150 percent of the Federal Poverty Level;
- A Center for Comparative Effectiveness Research (CER) within the Agency for Healthcare Research and Quality to conduct research on outcomes, effectiveness and appropriateness of health care services and procedures;
- A national strategy to improve the nation’s health through evidence-based clinical and community-based prevention and wellness activities; and
- A national voluntary insurance program for purchasing community living assistance services and supports.
The House measure will be financed through new fees and taxes, and cuts in Medicare. Finally, the bill would end unfair insurance practices such as not covering pre-existing conditions or eliminating individuals who become ill.
Contentious House debate included Democrats making major concessions regarding abortion insurance coverage to get the final votes for passage.
Next Steps: Senate Action
Majority Leader Harry Reid of Nevada said he would bring a bill to the floor as soon as possible. He is also working on a compromise package between bills passed by the Senate Finance and the Senate Health, Education, Labor and Pensions Committees. Once he reconciles the two competing bills, the House bill and Senate health care legislation will be merged by a joint congressional committee before being sent to President Obama for his signature.
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October 21, 2009
Academy Position on Health Care Reform
The Academy has been actively monitoring the current national dialogue on health care reform and has reviewed and analyzed pending health reform legislation. In addition, the Academy met with members of Congress and their staff to present its views on health reform and recently developed a position on this issue that is consistent with our mission statement and core purpose.
To read the position, click here. (PDF Download)
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October 21, 2009
Academy Writes to President Obama on Health Care Reform
On October 21, the Academy sent a letter to President Obama that outlines our opinions and concerns relative to health care reform.
To read the letter, click here. (PDF Download)
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October 21, 2009
Medicare SGR Legislation Update
Senate leaders failed to obtain the votes necessary to bring a bill, "The Medicare Physician Fairness Act of 2009" (S. 1776) to the Senate floor. The bill, which was estimated to cost $245 billion, would have permanently eliminated the sustainable growth rate (SGR) formula. The formula is used to calculate physician payment rates and will result in a 21.5 percent reduction in Medicare payments to physicians in January 2010 if Congress does not intervene and fix this problem.
Previously, Congress has blocked the cuts and provided annual updates for physicians under Medicare. The bill would also have prevented similar cuts in future years while Congress creates a new payment system. Some Senators who argued against S. 1776 said that it was not offset by spending cuts or revenue increases.
The Academy supported the bill and conducted a member alert to urge Senators to vote for it. Other support for the bill came from many medical societies and the American Association for Retired Persons. We will continue to update members on this important issue.
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October 13, 2009
Senate Finance Committee Passes Health Care Reform Bill
On October 13, the Senate Finance Committee passed 14-9 its version of the healthcare reform bill, "America's Healthy Futures Act". Senator Olympia Snowe (R-ME) cast the only Republican vote in favor of the legislation, solidifying her position as a key legislator in the bill negotiations once the debate moves to the Senate floor. Sen. Snowe indicated that although she voted to pass the bill out of committee, she would not guarantee a vote for the bill once it was brought to a vote on the floor. All of the committee's Democrats voted for the proposal, despite the bill's lack of a public option and an employer mandate.
Senate leadership must now merge the Finance bill with the Senate HELP Committee legislation. The Senate Finance bill, which recently scored at $829 billion, is considered the more conservative bill. Once the bills are merged, it is likely the single bill will need to be added to a revenue bill already passed out of the House. Press reports indicate that the Constitution requires revenue raisers, such as the healthcare reform bill, to start in the House.
The Finance proposal would require individuals to have health insurance, expand eligibility for Medicaid to 133 percent of the federal poverty level, create state health exchanges for the individual and small group markets and authorize the development of non-profit cooperatives.
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September 16, 2009
Senate Finance Committee Issues Health Reform Legislation
After many months of speculation, on September 16, Senate Finance
Committee Chairman Max Baucus (D-MT) unveiled the America’s Healthy Future Act, another
in a national compendium of comprehensive health care reform legislation and at a cost
of $856 billion. Earlier, Sen. Baucus released that Committee’s framework for the bill.
The bill is significant since the committee has jurisdiction over health programs under
the Social Security Act and health programs financed by a specific tax or trust fund.
Of importance to physiatrists, the bill would bar insurance companies
from discriminating against people based on their health status and prohibit denying
coverage because of pre-existing conditions.
The draft legislation does not include a government-run insurance
option but would establish a system of nonprofit consumer-owned co-operatives that would
compete with private insurers. The plan would permit negotiated rates rather than payment
based upon Medicare or other government-determined rates.
The legislation could be revised prior to formal consideration
which is slated for this week. Below is additional information regarding the legislation:
Members are asked to periodically check the Web site for updates
around health care reform.
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September 16, 2009
AAPM&R Advocates for Medicare SGR Reforms
The Academy, along with other medical societies signed on an AMA
letter to Senate members urging them to replace the Sustainable Growth Rate (SGR) formula
for calculating physician payment with a new Medicare physician payment system as part
of health system reform legislation. The Academy, along with the AMA and other specialty
societies has pushed for physician payment reforms and opposed the steep annual cuts
in Medicare physician payments that had to be averted by Congress since 2002.
To read the letter,
click here. (PDF Download)
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