Washington Watch
What happens on Capitol Hill affects ASHA members.
Final Days Approaching for Action on Medicare Therapy Cap
As the country awaits Congressional action to avert the fiscal cliff, other issues—such as the Medicare "doc fix" and the therapy cap exceptions process—must also be addressed before the end of the year. Absent Congressional action, the therapy caps will once again go into effect with a combined $1,900 cap for Medicare outpatient physical therapy and speech-language pathology services and a separate $1,900 cap for occupational therapy. Medicare reimbursement rates will decrease by 26.5%. Congressional leaders have signaled that they plan to address these issues as part of a larger economic package, but as of the publication of the newsletter, ASHA's advocacy team does not have specifics on any Medicare provisions. It is imperative that everyone take action on these important issues by going to ASHA's Take Action site. ASHA will inform members of any Congressional actions through Headlines and ASHA's advocacy page on Facebook.
U.S. Department of Education Tells States Not to Expect Sequestration Cuts for This School Year
In a recent memo to state education chiefs/superintendents, the U.S. Department of Education indicated that it would implement sequestration requirements from funds that would become available July 2013 for school year 2013–14, rather than from the 2012 advance appropriations. The Department also indicated that there was no reason to believe that a sequestration would affect funding for the 2012–13 school year. This memo is the Department's first official explanation of how it plans to implement automatic spending cuts required under the Budget Control Act (BCA) and set to go into effect on January 3, 2013.
ASHA members are cautioned against being overly optimistic based on this 7-month delay of federal budget cuts. If Congress and the President fail to change the BCA, all federal education programs will be cut next year, which will also have an indirect impact on all school-based personnel (e.g., fewer professional development opportunities). Funding for the Individuals with Disabilities Education Act (IDEA) will be cut by approximately $972.5 million for school year 2013–14, which translates into a $243 million cut to related services, including speech and hearing services.
We urge you to get involved and supplement our efforts by writing your members of Congress through our Take Action Center.
Hill Has Empty Calendar Until November
Both chambers of Congress have scrapped their October sessions, congressional leaders said, and won't return to work until after the November elections.
House Majority Leader Eric Cantor announced the House will not reconvene until Nov. 13. The House had planned a one-week session in Washington at the start of October, but scrapped that plan in anticipation of the Senate's passage of a House-passed resolution to keep the government running beyond the start of the new fiscal year.
The Senate as well adjourned on September 22nd after taking up the continuing resolution. As members launch the final stretches of their campaigns, the continuing resolution likely serves as the final major action until after the election.
Supreme Court Upholds Key Provisions in Affordable Care Act, But Congress Isn't Done Yet
Surprising many, the U.S. Supreme Court upheld the Patient Protection Affordable Care Act (ACA) last month. In a 5-4 decision written by Chief Justice John Roberts, the Court determined that the Act was constitutional under Congress' power to tax. In its decision, the Court looked at four key questions:
- Whether it was within Congress's constitutional power to impose an individual mandate to purchase health insurance;
- Whether all or any part of the law must be struck down if the individual mandate fell;
- Whether an expansion of Medicaid enrollments to the working poor in 2014 was unduly coercive on states; and
- Whether these questions could be reviewed before the mandate takes place.
The Court held that while the individual mandate is not a permissible exercise of Congress to regulate interstate commerce under the Commerce Clause of the US Constitution, as had been argued, it is a valid power of Congress to do so under its taxing authority. The entire Act was upheld, with the exception of the federal government's power to terminate states' Medicaid funds.
A major provision of ACA that was upheld is health insurance exchanges, organized marketplaces that will make health insurance available to previously uninsured or underinsured people. ASHA is working to ensure that habilitative and rehabilitative services—including those provided by audiologists and SLPs—are included in the plans' mandated essential health benefits and to define the scope of these services. For more information on this, visit The ASHA Leader website.
The provision that threatened states with the loss of their existing Medicaid funding if they declined to comply with the expansion under ACA was ruled unconstitutional. Medicaid is a federal/state program where states depend on federal matching funds to cover the cost of services to eligible individuals and nursing homes. The Court held that HHS cannot withhold a state's current matching funds to force them to expand their enrollments under the ACA. However, HHS can require states that volunteer to be granted additional matching funds to comply with the expanded Medicaid requirements starting in 2014.
Overall, in upholding the law, the provisions preventing insurers from denying coverage to children with preexisting conditions and allowing parents to maintain coverage for children up to age 26 on their parents' plans were upheld. The law also continues the creation of accountable care organizations (groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients) and the state health insurance exchanges where consumers may purchase plans. ASHA remains involved in addressing how these state health exchanges include habilitative and rehabilitative services performed by speech-language pathologists and audiologists and devices for participating health plans under the ACA.
Eager to voice their opposition to this bill, House Republicans voted for the 33rd time on July 11 for repeal of the Act. The Senate is not expected to take up the repeal for a vote at any time in the remainder of the current Congress. However, depending on the outcome of the November elections, this issue may be far from over.
ASHA Members 'Speak Out' on Budget Cut Impacts on IDEA
As the federal government faces the onslaught of budget enforcement mechanisms aimed at reducing the deficit by at least $2.1 trillion between January 1, 2013 and December 31, 2021, education professionals are working to inform lawmakers of the impact of cuts on students with disabilities. The Budget Control Act of 2011 requires automatic cuts of up to 9% on federal programs across the board in a process called sequestration. The Individuals with Disabilities Education Act is expected to take a big hit in the sequestration process. Luckily, the U.S. Department of Education recently released a memo to state education chiefs/superintendents indicating that it would implement sequestration requirements from funds that would become available July 2013 for school year 2013–14, rather than from the 2012 advance appropriations. The Department also indicated that there was no reason to believe that a sequestration would affect funding for the 2012–13 school year.
Being Heard
As part of the Speak Out, Be Heard program, ASHA is recruiting members to help educate legislators on the impact that further cuts to IDEA would have on school districts and students across the country. ASHA members can contact their members of Congress through the ASHA Take Action Center.
ASHA is also encouraging its members to set up meetings with their Representatives and Senators back home to discuss the impact of funding cuts during the ASHA Advocacy Week, which starts August 20. A toolkit on how to set up those meetings is on the ASHA website. ASHA members are encouraged to invite colleagues, or parents of children with disabilities, to their meetings.
Finally, it is critical that ASHA members and others interested in education learn about the issue and find out where their congressional candidates stand. November's results will have a tremendous impact on the outcome of the sequestration process. To learn more about your candidates, visit ASHA's Election website.
Will Education Pay the Price in the Budget Deficit Debate?
Since the Individuals with Disabilities Education Improvement Act (IDEA) was signed into law in 2004, the program's federal budget increased from $10.5 billion in 2005 to over $26 billion in 2011, before falling to only $11.9 billion in funding in 2012. Unfortunately, the cuts may only continue as the federal government grapples with required reductions in the federal budget deficit and does not take into account the impact these cuts will have on students with disabilities.
Last year, Congress passed the Budget Control Act of 2011, which established budget enforcement mechanisms to reduce the deficit by at least $2.1 trillion between January 1, 2013, and December 31, 2021–leaving us to wonder what programs will be impacted. Education programs (e.g., IDEA) are expected to take a big hit in the automatic cuts, a process known as sequestration [PDF]. Estimates suggest that funding for programs such as IDEA could be cut by an additional 9% in 2013, when 2012 funding levels are already $14 billion less than they were in 2011.
While other industries are working to reduce the impact of sequestration on their programs, ASHA is combining forces with other groups in the education sector to ensure that education programs for children with disabilities are protected.
Congress Votes to Extend the Therapy Cap Exceptions Process
What's Next?
On February 17, 2012, the House and Senate passed the conference report for H.R. 3630, the Middle Class Tax Relief and Job Creation Act, which among other things addressed the anticipated 27.4% cut to Medicare Part B reimbursements and extended the therapy caps exceptions process through December 31, 2012.
In extending the therapy cap exceptions process, Congress added additional safeguards to the exceptions process, including:
- The use of an NPI for the physician reviewing the need for therapy;
- Requirement of the KX modifier on claims above the cap; and
- Requirement for medical manual review when therapy expenditures hit $3,700 (combined physical therapy/speech-language pathology) for services furnished on or after October 1, 2012.
The bill will temporarily apply the therapy caps and exceptions to hospital outpatient departments for services provided no later than October 1, 2012, and ending December 31, 2012. In addition, the legislation will require two reports:
- A MedPAC report on how to improve the outpatient therapy benefit; and
- A General Accounting Office report on the effectiveness of the manual medical review process.
While extending the therapy caps exceptions process offers short-term relief to many patients and providers, ASHA and its partners are still working on a permanent solution. ASHA has been working closely with the American Physical Therapy Association and the American Occupational Therapy Association, as well as Congress, in the development of alternatives to the therapy cap and to develop an appropriate pathway to care for Medicare beneficiaries.
We urge you to get involved and supplement our efforts by writing your members of Congress through our Take Action Center.
Congressional Hearing Health Caucus Revived
The Congressional Hearing Health Caucus (CHHC) has been revived with the start of the second session of the 112th Congress. While the CHHC was not active last session, Representatives Tom Latham (R- IA) and Carolyn McCarthy (D-NY) have decided to revive the Caucus to broaden support and knowledge of hearing health issues within Congress. This bipartisan effort will allow for an educational setting for discussion of issues related to hearing health through periodic events and correspondence with all Members of Congress.