Cap Exceptions Process Expiring: Challenges and Opportunities in Lame Duck Session
By Stephanie Yamkovenko
The exceptions process to the Medicare therapy cap expires on December 31, 2010, and if Congress does not address the issue, more than 600,000 Medicare beneficiaries will be without access to the care they need. AOTA is urging Congress to extend the exceptions process, and we need the help and advocacy of all of our members to achieve this.
Following the midterm elections, the Congress returned to Washington this week to participate in what many call a “lame duck session,” which means some lawmakers are returning for their last session in Congress before newly elected officials convene at the beginning of the new year. Because they are no longer accountable to voters, lame duck members are often conflicted about how to proceed, which sometimes creates a barrier to passing controversial or costly legislation.
The lame duck session presents both opportunities and challenges for addressing the cap issue. Congress has many other items of business affecting occupational therapy practitioners to consider in the next few weeks, including the physician fee schedule cuts and other Medicare changes that are expiring. Yet of all of these issues, the therapy cap is the one most likely to affect patient care. AOTA staff commented that although in a lame duck session members of Congress have the opportunity to pass legislation they believe is right without fear of political ramifications, they also may choose to do what is politically expedient.
“The bottom line is that it costs money to reinstate the exceptions process,” says Christina Metzler, AOTA Chief Public Affairs Officer. “Even with a general acceptance that the therapy cap is bad policy, it will take aggressive action and advocacy to get the exceptions process extended.”
AOTA has been working for the past dozen years to suggest ways to ensure that only appropriate and beneficial therapy is provided, and especially that a clinician’s judgment best determines a client’s amount and frequency of therapy services, rather than using an arbitrary limit set by Congress.
For the past 5 years AOTA has successfully advocated for extending the exceptions process of the therapy cap, and once again the issue will be the main focus of our advocacy for the next 2 months. AOTA will be sending out action alerts to members; promoting virtual Capitol Hill days; and working in coalition with the American Physical Therapy Association, American Speech-Language-Hearing Association, the Parkinson’s Action Network, the Consortium for Citizens with Disabilities, and other groups.
A full repeal of the Medicare therapy cap is more expensive and difficult during a lame duck session, so the practical decision for now is to extend the exceptions process. AOTA expects to introduce legislation for a full repeal of the therapy cap in the 112th Congress.
“It’s a brand new environment and dynamic in the 112th Congress,” says Metzler. “Our high definition advocacy for the new year will be developing a strategy to educate all of the new members of the House and Senate about occupational therapy. We need to get active now for the cap, but we also need to be even more active at the beginning of 2011 to ensure the voice of occupational therapy is heard.”
AOTA volunteers and staff continue to participate in projects with the Centers for Medicare & Medicaid Services (CMS) contractors on developing an alternative to the cap, but these projects are not near completion.
“Occupational therapy practitioners need to understand that Medicare policy affects everyone, not just those working with Medicare beneficiaries,” says Metzler. “Private and other public payers use Medicare as a model for payment, and every practitioner needs to advocate for extending the exceptions process so that a clinician’s judgment is respected and patients receive the care they need.”
Stephanie Yamkovenko is AOTA’s staff writer.