Asclepios
Your Weekly Medicare Consumer Advocacy Update
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.
Medical Record
“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_
(http://www.kintera.org/TR.asp?a=lrKTIVODLjISKcJ&s=cnKBINPqE8LBKRNDG&m=iqIOL2OCJeJYE&af=y)
, 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_
(http://www.kintera.org/TR.asp?a=okIZJ4PPKmLZImI&s=cnKBINPqE8LBKRNDG&m=iqIOL2OCJeJYE&;
af=y) , Medicare Rights Center, February 2010)
Learn More About _Health Reform and Medicare_
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Part D Appeals: An advocate's manual to navigating the Medicare
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including real-life case examples, a glossary of important appeals terms, a
sample protocol for advocates, and links to important resources.
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of this great resource.
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