In late December Congress passed legislation that temporarily averts the proposed 21.1% decrease in the 2010 Medicare Physician Fee Schedule (The ASHA Leader, Dec. 15, 2009). The legislation postpones the cuts in Medicare Part B payments for 60 days past the scheduled Jan. 1 implementation date to give Congress time to finish debate on comprehensive health care reform.

Although the bill keeps Medicare reimbursement levels at 2009 rates for 60 days, it does not extend the 2009 provision that allows an exceptions process for beneficiaries who exceed the maximum amount of therapy allowed per year. ASHA worked unsuccessfully with other stakeholders to halt the reinstatement of therapy caps; the exceptions process was stripped from the bill prior to the vote on the bill in the House of Representatives.

Speech-language pathologists should begin advising their patients that the Centers for Medicare and Medicaid Services will begin enforcing the $1,860 maximum on combined physical therapy and speech-language pathology services in 2010.

Health Care Reform

Payment and therapy cap issues are addressed in the broader congressional effort to enact health care reform legislation. The two chambers, however, address the issues differently. The current Senate version, the Patient Protection and Affordable Care Act (H.R. 3590), calls for a one-year increase of 0.5% to the Medicare Physician Fee Schedule, and provides for a one-year extension of the therapy cap exceptions process.

The House legislation, American's Affordable Health Choices Act (H.R. 3962), is more aggressive. It would change the current Medicare Part B payment formula—now based on a calculation known as the "sustainable growth rate"—to one based on the gross domestic product (GDP). Under the House proposal, reimbursement rates for SLPs and audiologists would most likely be updated annually by the calculation of GDP plus 1%. The House bill would extend the therapy cap exceptions process through 2011.

The House passed its version of health care reform in the fall, and the Senate passed its legislation at the end of December. Reconciliation of the two pieces of legislation is expected to be difficult, although congressional leadeers have stated they want to vote on the bill by the end of January. ASHA will continue to work with Congress and other stakeholders to ensure that Medicare beneficiaries continue to have access to outpatient therapy services and that reimbursement levels for providers are not drastically cut.