The massive health care reform bills recently passed by the full U.S. House of Representatives and by the Senate Finance Committee define rehabilitative and habilitative services as essential elements of a basic health insurance benefit package and also require coverage of hearing services, equipment, and supplies for children under 21.
An earlier report by the Senate Finance Committee indicated that insurance companies would need to provide these benefits. The proposal is viewed as the base bill from which lawmakers will develop a compromise; however, it must be combined with legislation passed earlier this year by another Senate committee—Health, Education, Labor and Pensions (HELP).
Although the Senate is now closer to full consideration of a proposal, it is just the beginning of intense negotiations required to pass a final bill. After the full Senate passes combined legislation, that proposal must then be reconciled with the House version in a conference committee. After the conference agrees on a bill, it would then go back to the Senate and House for passage before going to the president for signature.
In the House, three committees worked together to introduce one bill, H.R. 3200, America's Affordable Health Choices Act of 2009. Each committee had the opportunity to amend the legislation, which recently passed the House by a 220–215 vote;
ASHA is taking no formal position on health care reform. The association has, however, been working to ensure that issues identified as priorities in ASHA's public policy agenda are included in the proposals receiving serious consideration in Congress. ASHA's public policy agenda is developed by input from ASHA members committees and staff. (Search "2009 public policy agenda" at ASHA's Web site.)
Coverage of Services
The House bill and both Senate bills define rehabilitative and habilitative services as a basic benefit that must be provided by all health insurance plans. (see "From the President," p. 20.) The House and Senate Finance proposals provide an additional provision that would require health insurance plans to cover hearing services and devices for children under age 21.
Health insurance carriers historically have attempted to deny coverage of speech-language pathology and audiology services to children with communication disorders. Although many communication disorders are medically based and caused by a neurological injury or dysfunction that affects communication skills, insurance policies frequently label these disorders as developmental or educational and deny services to treat them.
In a Sept. 21 letter to the chairman of the Senate Finance Committee, ASHA urged the committee to agree to the HELP language on this issue, arguing that private health insurance will usually cover rehabilitative services for children who incur cognitive or physical disorders as a result of an injury or illness, but deny those same services for children who are born with cognitive or communication disorders.
Medicare Fee Schedule
Without congressional intervention, providers will face a 21.2% cut to Medicare Part B reimbursement rates in January 2010, with additional cuts projected every year. This mandated fee cut is due to a flaw in the formula used to set yearly Medicare payment rates; Congress, however, usually rescinds the scheduled fee cut before its effective date. Although the rates are designed for Medicare, many private insurance companies also use them as the basis for their provider rates.
The Senate Finance Committee's proposal would halt the cuts for one year and increase reimbursement rates by 0.5% for 2010. The House proposal does not address the issue; a separate bill, H.R. 3961, would replace the current formula and calls on the Center for Medicare and Medicaid Services to further refine the fee schedule process in 2011.
Congress has had difficulty developing and passing a permanent fix to this problem because of the cost of replacing the current system and finding offset funds within the Medicare program to pay for such repeal. Sen. Debbie Stabenow (D-Mich.) has introduced S. 1776, which would permanently repeal the flawed formula and allow the payment issue to be addressed outside of health care reform and, therefore, be free of budget neutrality requirements.
The health care proposals call for a two-year extension of the Medicare therapy cap exceptions process. Without action on this issue, therapy caps (which place limits on covered occupational and physical therapy and speech-language treatment) return on Jan. 1, 2010.
The exceptions process is a short-term solution, but a long-term solution is needed. ASHA has been involved as a key stakeholder in the development of short- and long-term solutions to therapy caps, and is participating in CMS efforts to develop alternatives.
Student Loan Repayments
The House proposal would create a new student loan repayment program for health care providers—including speech-language pathologists and audiologists—who commit to work for at least two years in areas of health professional shortages. The program parameters, including amounts of loan repayment and placement, would be stipulated by the secretary of health and human services. The provision is based on H.R. 2891, the Access to Frontline Health Care Act of 2009, introduced by Reps. Bruce Braley (D-Iowa) and Zack Space (D-Ohio).
ASHA worked with a coalition of organizations on the inclusion of language that would have permitted Medicare providers to offer telepractice services. The provision, similar to legislation introduced by Mike Thompson (D-Calif.), was deemed too costly to be included in the final House version of health care reform. However, Sen. Tom Udall (D-N.M.) recently introduced S. 2741, which would demonstrate the effectiveness of telepractice for individuals receiving post-acute care after a stroke; ASHA is working to have that provision included in the Senate reform package.
A Long Road Ahead
Although health care reform may be on its way to quick passage in both the House and Senate, negotiations will be needed to develop a compromise bill that can be passed by both chambers and signed into law.
In addition, the specifics of the law would need to be worked out during a potentially long regulatory process. ASHA will continue to work with Congress and within coalitions to ensure that ASHA's policy initiatives are considered as part of health care reform debate.
For more information on ASHA activities related to therapy cap alternatives, contact Kate Romanow, JD, ASHA director of health care regulatory advocacy, at firstname.lastname@example.org.