Speech-language pathologists and audiologists in health care settings could face cuts to Medicare reimbursement levels, pay freezes, reductions in staff, and other cost-cutting measures as Congress works to comply with federal debt ceiling legislation.
Under the Budget Control Act of 2011 passed in August, a 12-member bipartisan joint committee must identify ways to reduce the deficit by at least $1.5 trillion over 10 years (The ASHA Leader, Sept. 20, 2011). President Obama, the President's Fiscal Commission, and the House Ways and Means Committee have submitted proposed cuts to the Joint Select Committee on Deficit Reduction, which must present its recommendations to both chambers of Congress by Nov. 23.
Congress must pass the recommendations by Dec. 23 to avoid triggering automatic spending cuts, which include a 2% across-the-board reduction in Medicare reimbursement rates.
The committee is chaired by Rep. Jeb Hensarling (R-Texas) and Sen. Patty Murray (D-Wash.), and includes Senate Democrats Max Baucus (Mont.) and John Kerry (Mass.); Senate Republicans Jon Kyl (Ariz.), Rob Portman (Ohio), and Pat Toomey (Pa.); House Democrats Xavier Becerra (Calif.), Jim Clyburn (S.C.), and Chris Van Hollen (Md.); and House Republicans Dave Camp (Mich.) and Fred Upton (Mich.). Observers question whether the committee can develop recommendations that will pass the Democratic-led Senate and the Republican-led House. Republicans favor cutting expenditures only; Democrats want to include revenues in the debt ceiling reduction package.
The White House issued cost-cutting recommendations to the committee in the President's Plan for Economic Growth and Deficit Reduction [PDF]. The document includes approximately $320 billion in health care savings over the next 10 years—$248 billion in Medicare and $73 billion in Medicaid and other health programs—through cost savings related to post-acute care, certain hospital and Medicare Part D drug payments, and increased beneficiary premiums and cost-sharing.
Recommendations from House Ways and Means Committee Democrats and the President's Fiscal Commission include:
- Adding new or increasing beneficiary co-payments for home health and skilled nursing facility services.
- Requiring skilled nursing facilities to pay back 2011 Medicare overpayments that occurred because of changes in the resource utilization groups that determine reimbursement levels.
- Adjusting home health agency reimbursement rates.
- Raising the inpatient rehabilitation facility (IRF) compliance threshold—a rule that requires an IRF to have a minimum number of cases that have one or more selected conditions—from 60% to 75%, thereby reducing improper Medicare payments.
Private practitioners, hospitals, inpatient rehabilitation facilities, long-term care facilities, and home health care agencies could feel the effects from any of these measures, requiring cost-cutting measures of their own, such as reducing clinicians' hours, freezing salaries, cutting staff, or leaving open positions unfilled.
ASHA is preparing a letter to the committee advocating on behalf of programs that help individuals with communication disorders. ASHA will then ask members to take action by contacting their congressional representatives to support this message. Watch your e-mail for ways to get involved.