Although both houses are currently in recess for the Thanksgiving break, major appropriations and reconciliation bills top Congress’ agenda for the last few weeks of the year. With the House adjourned until Tuesday, December 6, and the Senate scheduled to return on the following Monday, the Budget Reconciliation for FY 2006 is expected to make its way to Conference during the week of December 12 th.

ASHT is pleased that the Senate’s version of the Budget Reconciliation contains a one-year moratorium extension of the $1,500 Medicare annual cap for therapy services per beneficiary. While the House’s legislation does not contain the moratorium, it may survive Conference, which is why members of the Conference Committee will need to hear from the ASHT membership. Please click here for a draft letter to submit.

The moratorium on therapy caps is a high priority issue for ASHT, and government relations representatives will continue to keep membership aware of the Budget Reconciliation as it moves forward and a final version is adopted.

In other news, the United States Government Accountability Office (GAO) reported, on November 10, that the Centers for Medicare and Medicaid Services (CMS) has made little progress in developing a new payment system for outpatient therapy that considers the needs of individual Medicare beneficiaries.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 required the GAO to report on whether available information justifies waiving the caps for particular conditions or diseases. The GAO also addressed the status of the Department of Health and Human Services’ (HHS) efforts to develop a needs-based payment policy and whether circumstances leading to the caps have changed.

What the GAO found, in fact, was that the data and research available are insufficient to identify particular conditions or disease to justify waiving Medicare’s outpatient therapy caps. They observed, however, that HHS, despite several statutory requirements, has made little progress in determining how to standardize and collect information on the health and functioning of patients receiving outpatient therapy services. This missing information, the GAO argued, is “a key part of developing a system based on individual needs for therapy.”

In its report, the GAO suggests that “Congress give HHS interim authority to allow, under certain conditions, payments exceeding the caps after the moratorium expires.” Furthermore, the GAO recommends that HHS accelerate developing a means to evaluate beneficiaries’ therapy needs. And lastly, the GAO also suggests that HHS should “improve its system for identifying improper therapy claims beyond initiatives already under way.” The report, titled Medicare: Little Progress Made in Targeting Outpatient Therapy Payments to Beneficiaries’ Needs, can be found HERE.