With Health Reform Stalled, Medicare Coverage For Some Therapies Subject To Caps

Stalled health care reform efforts have created several unresolved issues, some of which related to Medicare and Medicaid.

The Hill: "Medicare beneficiaries face a steep cliff in their coverage for physical therapy and similar treatments due to Congress's failure to enact a healthcare reform bill. On Jan. 1, the clock started ticking for those patients who need physical, occupational or speech therapy, which is now subject to an annual limit on benefits." The pending legislation "included language to block the so-called therapy caps, but with that bill sidelined, beneficiaries and therapy providers are seeking other means to keep the money flowing. Medicare beneficiaries now face annual limits of $1,860 for physical and speech therapy [combined] and $1,860 for occupational therapy" (Young, 2/3).

CQ HealthBeat: "The cap is subject to an exceptions process that exempts virtually all Medicare patients. However, legislation that provides for exceptions to the cap ran out at the end of 2009." The Senate health bill included a one-year extension while the House measure had a two-year extension. "An estimated 14 percent of Medicare patients who receive rehabilitation services exceed the cap each year, according to a recent letter from 30 provider and patient organizations to congressional leaders." Legislation to extend the exceptions process usually advances with efforts to prevent Medicare physician payment reductions (Reichard, 2/3).

Meanwhile, Congress Daily reports that Senate Majority Leader Harry Reid, D-Nev., and Sen. Jay Rockefeller, D-W.Va., are preparing a bill to give states additional funds for Medicaid services and hoping to add it to the jobs bill the Senate will take up shortly. The senators argue that "the measure will retain state jobs and relieve budget pressures. States tend to look to Medicaid first when budgets are squeezed. States and the federal government share the responsibility for funding the program for low-income people. The measure will extend by six months an increase in the formula used to determine the federal match that was included in last year's economic stimulus" (Sanchez and Edney, 2/3).

The Associated Press/Seattle Times: "Among states, California arguably has the most to gain from an overhaul of its health care system: it has the greatest number of uninsured residents in the country and the largest public insurance program for the poor, which struggles to serve 6.5 million people while reimbursing doctors at one of the nation's lowest rates." Last week, more than 200 people protested and called for health care reform in front of Sen. Dianne Feinstein's San Francisco office. "Tired of waiting for action on the national front, members of the California Senate approved last week a plan calling for a single-payer health care system. The bill was sent to the Assembly, although Gov. Arnold Schwarzenegger has already vowed to veto it, as he has two similar proposals" (Barbassa, 2/4).

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