Reinstatement of Medicare Rehabilitation Benefit Act of 1998

[Guest guest]

Listed below is a summary and some pertinent comments on HR 3835 -

Reinstatement of the Medicare Rehabilitation Benefit Act of 1998.

This bill would appeal the $1500 cap and needs your attention and support.

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STATUS: Detailed Legislative Status

House Actions

May 12, 98:

Referred to the Committee on Commerce, and in addition to the Committee on

Ways and Means, for a period to be subsequently determined by the Speaker,

in each case for consideration of such provisions as fall within the

jurisdiction of the committee concerned.

May 26, 98:

Referred to the Subcommittee on Health and Environment.

May 12, 98:

Referred to the Committee on Commerce, and in addition to the Committee on

Ways and Means, for a period to be subsequently determined by the Speaker,

in each case for consideration of such provisions as fall within the

jurisdiction of the committee concerned.

STATUS: Congressional Record Page References

05/12/98 Introductory remarks on Measure (CR E831)

COMMITTEE(S):

· COMMITTEE(S) OF REFERRAL:

· House Commerce

· House Ways and Means

· SUBCOMMITTEE(S):

Hsc Health and the Environment

AMENDMENT(S):

***NONE***

21 COSPONSORS:

Rep Cardin - 05/12/98Rep Fox - 05/12/98

Rep Christensen - 05/12/98Rep Cook - 05/12/98

Rep English - 05/12/98Rep Rahall - 05/12/98

Rep Chenoweth - 05/12/98Rep Gibbons - 05/12/98

Rep Nussle - 05/12/98Rep Deutsch - 05/12/98

Rep LaTourette - 05/18/98Rep Leach - 05/18/98

Rep Bonior - 05/18/98Rep Frost - 05/18/98

Rep Traficant - 05/21/98Rep Sawyer - 05/21/98

Rep Kaptur - 05/21/98Rep Hooley - 06/03/98

Rep Maloney, J. - 06/03/98Rep s - 06/03/98

Rep , C. - 06/03/98

SUMMARY:

(AS INTRODUCED)

Reinstatement of the Medicare Rehabilitation Benefit Act of 1998 - Amends

title XVIII (Medicare) of the Social Security Act to repeal the financial

limitation on rehabilitation services under part B (Supplementary Medical

Insurance) of the Medicare program.

Provides that for outpatient physical therapy services, outpatient

occupational therapy services, and outpatient speech-language pathology

services covered under Medicare and furnished on or after January 1, 2000,

the Secretary of Health and Human Services shall implement a new payment

methodology based on the classification of individuals by diagnostic

category, functional status, and prior use of services in both inpatient

and outpatient settings. Requires that such payment methodology be designed

so that, taking into account the increased expenditures resulting from this

Act, it does not result in any increase or decrease in the expenditures

under Medicare on a fiscal year basis.

HON. JOHN E. ENSIGN

in the House of Representatives

TUESDAY, MAY 12, 1998

· Mr. ENSIGN. Mr. Speaker, today I rise to introduce the `Reinstatement of

the Medicare Rehabilitation Act (RMRA) of 1998.' RMRA repeals the $1,500

annual limits on physical and occupational rehabilitation services

established by the Balanced Budget Act of 1997 (BBA) which are set to go

into effect on January 1, 1999 and requires the Health Care Financing

Administration to implement a budget neutral alternative payment system no

later than January 1, 2000.

· In a rush to find savings in the Medicare program last year, Congress

imposed an arbitrary $1,500 annual limitation on most outpatient

rehabilitation services. Unlike other BBA provisions, the $1,500 limits

were adopted without the benefit of committee hearings or a detailed

analysis by HCFA of their likely effects on beneficiaries' ability to

obtain medically necessary services.

· In fact, analyses undertaken since the enactment of the BBA indicate that

implementation of the limits will have a disproportionate effect on the

most vulnerable Medicare beneficiaries, including victims of stroke and

other debilitating conditions which require concentrated therapy services.

A $1,500 annual payment may be sufficient to address the `average' case,

but it will not be adequate for beneficiaries who require more intensive

services. The option of transporting non-ambulatory resident of a skilled

nursing facility or other rehabilitation setting to an outpatient hospital

department will be disruptive to patients and ultimately more costly to the

Medicare program. Savings will be achieved only if this inconvenience and

disruption cause patients to forgo medically necessary services to which

they are entitled under the Medicare program.

· More importantly, American seniors have been encouraged to expect

Medicare to cover the cost of medically necessary treatment, subject to

reasonable copayments and deductibles. The existence of an arbitrary

coverage limitation on otherwise medically necessary services will likely

come as a shock to affected beneficiaries and their relatives, often at a

time of great stress. Surely, a less disruptive approach can be found to

achieve program savings.

· VSPA will prevent the $1,500 annual limitations from taking effect on

January 1, 1999 and will require HCFA to develop and implement an

alternative payment system for outpatient physical therapy, occupational

therapy, and speech-language pathology services. Rather than limiting the

availability of medically necessary services by imposing an arbitrary

annual dollar limitation, the new system would be based on patient need.

Payments would be based on patient classification by diagnostic category

and would take into account prior use of services in both inpatient and

outpatient setting. Payment rates would be established in a budget neutral

manner. Mr. Speaker, I acknowledge that I did not oppose the inclusion of

this provision in the Balanced Budget Act. ly, we did not understand

how unfairly it could affect the most vulnerable of Medicare beneficiaries.

Now that we have that information, we should not be reluctant to correct a

policy which we now know will cause great hardship and unfairness.

· For these reasons, I urge my colleagues to join me in support of the

Reinstatement of the Medicare Rehabilitation Benefit Act of 1998.

R. Kovacek, MSA, PT

KovacekManagementServices, Inc.

The FOCUS Group, Inc.

20225 Danbury Lane

Harper Woods, MI 48225

Fax

Email Pkovacek@...

<http://www.theFOCUSgroup.net>

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