Handing a victory to speech- language pathologists and Medicare patients, Congress included a two-year moratorium on the Medicare outpatient therapy caps in the Medicare prescription drug bill passed immediately before the Thanksgiving adjournment.
The Senate voted 54-44 in favor of the controversial bill on Nov. 25, which paved the way to send the bill to the White House for President Bush to sign. The House approved the legislation a few days earlier.
"Passage of this provision is a big win for everyone involved in providing rehabilitation to Medicare patients, but most importantly to the patients themselves," said ASHA President Glenda Ochsner. "The sustained advocacy by ASHA members has made a real difference on this issue.
"Our congressional supporters also helped us succeed, which is a tribute to the ASHA-PAC and the members who have contributed to our political action committee."
The bill includes a two-year (2004–2005) moratorium on the Medicare outpatient therapy caps. The legislation also suspends the 2003 caps upon becoming law. This bigger-than-expected win can be attributed to ASHA’s efforts to educate federal lawmakers about the harmful impact of the caps.
Earlier in the fall, the conference committee included a one-year moratorium on the caps for 2004, but given the unpredictable nature of conference committees, that agreement was tentative and ASHA continued pushing hard on the issue.
The final victory came after a breakneck 72 hours during which the one-year moratorium agreed upon earlier was nearly removed due to parliamentary maneuvers. However, when the price tag of the prescription drug package came in under the $400 billion allowed under the budget resolution, congressional supporters managed to direct some of that money to extension of the moratorium.
The Medicare legislation additionally requires previously mandated reports on alternatives to the single annual dollar cap for outpatient therapy to be submitted to the General Accounting Office to develop criteria for identifying conditions or diseases that could be granted a waiver from the caps by October 2004.
"This dramatic turnaround is a tribute to everyone who’s worked so hard on this issue for so many years," said Kate Gottfred, ASHA’s vice president for governmental and social policies. "When the possibility for an additional year’s extension came up suddenly, we were able to take advantage of it because of our long-term advocacy.
"In lobbying, sustained efforts can bring sudden and unexpected rewards," she said. "Obviously, there’s more work ahead as we seek a permanent solution to the cap, but now we’ve got some breathing room."
In addition, Congress included a legislative fix to the conversion factor of the Medicare fee schedule. A 4.5% reduction in overall 2004 reimbursement rates was suspended, and the conversion factor was increased by 6%, a 1.5% increase over the 2003 rate. Once the legislation becomes law and the Centers for Medicare and Medicaid Services establish the new 2004 conversion factor, it will be reflected in ASHA’s 2004 Medicare fee schedule for audiologists and 2004 Medicare fee schedule for speech-language pathologists that are available on ASHA’s Web site.
President Bush signed the legislation into law on Dec. 8.
For more information on the Medicare reform bill, contact Reed Franklin at rfranklin@asha.org. For details on the 2004 Medicare fee schedule, contact Mark Kander at mkander@asha.org or Ingrida Lusis at ilusis@asha.org.