ASHA Continues Fight to Stop Medicare Cuts

Audiologists and speech-language pathologists (SLPs) were facing significant payment cuts to Medicare Part B (outpatient) services at the beginning of 2021. Advocacy by ASHA and other stakeholders resulted in legislation that prevented some of the payment cuts and mitigated other payment cuts for the duration of the year.

Last week, Congress passed legislation addressing some but not all of these cuts for 2022.

Why is this Happening?

The Medicare payment cuts are the result of three separate statutory provisions designed to control federal spending:

1. Statutory “Pay-As-You-Go” (PAYGO), which requires new legislation increasing the federal deficit to be offset by reduced spending elsewhere.
2. Sequestration, which stems from a 2011 law that requires across-the-board spending cuts when federal spending exceeds certain thresholds.
3. Budget neutrality, which requires payments under the Medicare Physician Fee Schedule (MPFS) for Part B outpatient services to remain balanced. This means that payment increases to some services results in cuts to others.

Combined cuts from these provisions threatened reductions in Medicare payments to audiologists and SLPs by 10% or more in 2022.

ASHA’s advocacy efforts throughout this year have focused on reversing these cuts in their entirety and working toward a long-term solution to stabilize Medicare payment policy. This summer, ASHA led a letter to congressional leaders [PDF] urging relief from the cuts for two years. In October, ASHA helped build support for a congressional letter [PDF], led by Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN), that was signed by 247 members of the House of Representatives, urging congressional leaders to address each of the looming Medicare payment cuts to health care providers. Two weeks ago, ASHA again called on Congress to address imminent Medicare payment cuts [PDF]. And most recently, ASHA developed and signed a letter with other physician and nonphysician providers calling on Congress to stop the cuts before the end of the year to ensure patient access to audiology, speech-language pathology, and other critical health care services.

How Did Congress Respond?

Congressional leaders responded by passing the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610). This legislation, which President Biden has signed into law, addresses Medicare payment cuts for 2022 by a total of 7.75%:

1. Statutory PAYGO, which would have cut Medicare payments by 4%, is fully eliminated for 2022.
2. Sequestration, which would have cut Medicare payments by 2%, is eliminated during the first quarter of 2022, then reduced to a 1% cut in the second quarter, and then returns to a 2% cut for the third and fourth quarters, resulting in an overall 1.25% cut for 2022.
3. Budget neutrality, which would have cut Medicare payments by 3.75%, is reduced to a 0.75% cut for 2022.

What Does This Mean for Audiologists and SLPs?

The Centers for Medicare & Medicaid Services (CMS) will apply the three payment adjustments differently, as outlined below.

1. Statutory PAYGO adjustments are made at the claim level, meaning that the 4% decrease would have been applied after coinsurance, deductibles, and Medicare secondary payment adjustments. S. 610 stops this 4% negative adjustment from being applied to your claims through 2022.
2. Sequestration adjustments are also made at the claim level. This means there will be no adjustments made to your claims in the first quarter of 2022. For the remainder of the year, you will see a negative 1% adjustment in the second quarter and a negative 2% adjustment in the final two quarters. In other words, providers will experience a cumulative 1.25% negative adjustment to claims in 2022, phased in during the last three quarters of the year.
3. Budget neutrality adjustments are made to the conversion factor, which is the dollar amount used to calculate payments at the procedure code level. This means that providers will experience a 0.75% decrease to every service you bill to Medicare, before coinsurance, deductibles, and other payment adjustments are applied at the claim level.

In addition to the adjustments outlined above, CMS estimated an overall net-zero change in payment for audiology services and a 1% decrease for speech-language pathology services due to other policies implemented in the 2022 MPFS. As a result, audiologists will see an estimated 0.75% decrease to payments in the first quarter, a 1.75% decrease in the second quarter, and a 2.75% decrease in the third and fourth quarters. Speech-language pathologists will experience an approximate 1.75% decrease in the first quarter, a 2.75% decrease in the second quarter, and a 3.75% decrease in the third and fourth quarters. Keep in mind that the direct, cumulative impact of payment adjustments on individual clinicians or practices will vary depending on several factors, including locality-specific rates and the specific procedure codes billed. It is also important to note that these 2022 adjustments are in addition to the approximate 2-5% cuts to audiology and speech-language pathology services that were implemented in 2021.

ASHA remains fully committed to fighting any cuts to Medicare reimbursement. While far from ideal, S. 610 reduces near-term Medicare payment cuts—which could have been as high as 10% or more—allowing additional time for ASHA to continue working toward a long-term policy solution. ASHA will provide a detailed analysis of changes and their impact on payment for audiology and speech-language pathology services once CMS provides additional guidance.

Learn more about ASHA’s ongoing efforts to stop the Medicare payment cuts.

Get Involved!

Join the fight to convince Congress to more fully address these cuts by urging support for the Supporting Medicare Providers Act of 2021(H.R. 6020/S. 3314)—which would more substantially mitigate cuts related to budget neutrality—and for stopping resumption of the 2% Medicare sequester cuts in their entirety next year.

ASHA will continue to provide updates on these issues as developments warrant.

Questions?

For questions on congressional action, please contact Josh Krantz, ASHA’s director of federal affairs, health care, at jkrantz@asha.org.