Progress Seen on Addressing Therapy Cap Problem

Although snowstorms have wreaked havoc on the NASL Winter Legislative and Regulatory Conference while bringing most of Washington to its knees, Capitol Hill is still working behind the scenes on legislation to address several key Medicare issues..  Text of a proposed Senate “jobs bill” was released today, which includes three Medicare provisions important to NASL members: 

• Extension of the therapy cap exceptions process through December 31, 2010 (Sec. 613, Page 107)
• Extension of the current level in the Physician Fee Schedule through September 30, 2010 (Sec. 612, Page 107)
• Extension of the GPCI (rural payments) floor through December 31, 2010 (Sec. 617, Page 113) 

Senate Democrats hope to add Republican support to the bill, which includes a number of tax provisions, and there appears to be sufficient support for quick passage of the bill.

Unfortunately, the approaching winter storm that forced NASL to postpone the Winter Conference also prompted the House to cancel floor votes for the rest of this week. Next week is a scheduled district work period to commemorate the President’s Day holiday. While there had been hope that this legislation might reach the Senate floor by the end of the week, action probably will not be completed until the House and Senate reconvene the week of February 22. However, it appears that we are finally moving closer to restoring access to therapy services for Medicare beneficiaries.

Therapy Cap Update

NASL participated in a meeting of therapy cap stakeholders this afternoon to discuss efforts to promote the passage of legislation to extend the therapy cap exceptions process. The Senate election in Massachusetts last Tuesday has essentially halted health reform negotiations, and it is causing congressional leaders to step back and reassess their strategy for moving forward.  There is now considerable uncertainty about the prospects for passing health reform this year.  

Even if Congress were to proceed with a health reform bill, it could take some time to draft a revised plan, which makes it a less than ideal vehicle for addressing the therapy caps issue. NASL and other therapy organizations are mobilizing to press for the expeditious consideration of therapy cap relief, and we are exploring all avenues to accomplish this goal.

We know that with each passing day, more patients are in danger of hitting or exceeding the caps.  While the congressional commitment to address the therapy caps problem remains strong, and we believe they will make any solution retroactive to January 1, 2010, we cannot take anything for granted. While NASL members can feel optimistic that a solution will occur eventually, providers and patients should plan for further disruptions in the short term. 

As we seek congressional action, we need to continue to generate constituent correspondence. The NASL advocacy website has processed more than 2,300 messages since Friday, but a noisy constituency is necessary to educate legislators and put them on notice that patients are beginning to experience a disruption in care because of the imposition of the therapy caps.

In addition to our electronic advocacy campaign, NASL and its allies are: 

• Contacting key legislators and staff to seek prompt consideration of therapy relief legislation
• Sending a joint letter to congressional leaders signed by a host of provider and patient groups
• Planning a therapy cap press conference featuring legislators and representatives from patient groups
• Preparing to place paid advertising in key Capitol Hill publications
• Engaging other organizations such as American Association of Retired People (AARP) and the Military Officers Association of America (MOAA) to become active on this issue

Action Needed 

• Please urge your employees to visit the NASL Advocacy Center www.capwiz.com/nasl to send messages to their legislators in support of the exceptions process.  NASL has prepared a “Dear Employee” letter that you can use to alert your employees. 

• Please call your legislator to reinforce the message. You can use the NASL Advocacy Center www.capwiz.com/nasl to find contact information for your legislators. Click on the “Elected Officials” tab, and then enter your Zip Code. Click on your representative or senators, and then click the “Contact” tab to find information about contacting them by telephone. You can call either a local office or the Washington office. If you call the Washington office, please ask to speak with the Health Legislative Assistant. These talking points might help you present your message. 

• As your patients reach the cap, please document problems your patients are encountering and provide vignettes to Alan Peterson alan@nasl.org, so we can build an inventory of examples to show Congress. We understand that companies might be reluctant to disclose exact numbers of patients affected, but estimates would be helpful. Things that would be helpful to know with individual case studies include the following: 
  • The diagnosis of the beneficiary, and why they were receiving outpatient therapy
  • Therapy disciplines involved in the treatment
  • The demographics of the beneficiary (Age? Rural? Complicating factors?)
  • How the beneficiary was benefiting from therapy and implications of halting care
  • Why transferring care to a hospital outpatient department for therapy was not appropriate (Cost? Distance? Treatment?)

NASL Advocacy Center

The NASL Advocacy Center www.capwiz.com/nasl is primed to facilitate grassroots action by NASL members and their employees on the therapy cap issue.

The NASL site is easy to use and requires a minimum amount of effort.  A sample letter is posted, and while we encourage people to personalize their messages, it is not required.  Employees can send e-mail messages to their legislators simply by adding their names and addresses to the letter we have prepared.  People sending messages through the site will receive a confirmation message from NASL.

It is not necessary for people to know the names and addresses of their legislators in order to send messages.  All we need is a person’s Zip Code in order to match them with their legislators – the advocacy center does the matching automatically. 

In order for the advocacy center to be effective, we need your help in encouraging employees to visit the site.  The NASL Advocacy Center provides an easy way for your employees to register their concerns on the therapy cap issue with their legislators.

Therapy Cap Advocacy Update

NASL and other therapy stakeholders have been working with patient groups in pressing Congress to pass legislation to extend the therapy cap exceptions process. A letter signed by nearly 40 patient and provider groups has been sent to House and Senate leaders. This has provided some much-needed press coverage about the problem. The newspaper The Hill and two subscription publications carried stories yesterday about the therapy cap problem.

NASL is working with another coalition representing groups supporting 10 of other Medicare “extenders” that were allowed to expire January 1. In addition to therapy caps, these provisions were also allowed to lapse: 

• Work geographic index floor and revisions to the practice expense geographic adjustment under the Medicare physician fee schedule
• Payment for technical component of certain physician pathology services
• Ambulance add-ons
• Certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities
• Physician fee schedule mental health add-on
• Outpatient hold harmless provision
• Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas
• Rural Community Hospital Demonstration Program
• Medicare-dependent hospital (MDH) program
• Hospital wage index improvement 

A separate coalition letter representing all of the groups interested in these extenders will be sent to congressional leaders next week.

Meanwhile, the NASL Advocacy Center www.capwiz.com/nasl has generated more than 6,500 messages to congressional offices, and the information you have provided to NASL regarding patient vignettes and numbers of people reaching therapy caps has been used to bolster our advocacy efforts. 

It appears that Congress is finally getting the message. We have received reports from several different sources that Congress intends to address the therapy cap problem later this month. A jobs bill and a tax extenders bill are the likely legislative vehicles for this effort.

We hope to provide more clarity at the NASL Winter Legislative and Regulatory Conference next week. In the meantime, please continue to support our grassroots efforts by directing your employees to the NASL Advocacy Center.  We need to keep up the pressure on this issue.

If you are attending the NASL conference, please consider setting up appointments to see your legislators. Please visit the NASL Advocacy Center www.capwiz.com/nasl and click on “Elected Officials” tab to find your legislator – telephone numbers and addresses are available on the “Contacts tab.”  You might be asked to put your request in writing.