The 109th Congress kicked off its first session of 2005 on January 4 in what is likely to be a contentious and partisan year. As a result of the election, the Senate Republicans gained 4 seats to achieve a 55-44-1 majority; the House of Representatives also added 3 Republican seats and now stands at 232-201-1, with one vacancy. Featuring prominently this year will be a major budget fight over the fiscal future of Medicare and Medicaid. The battle over Medicare competitive bidding will heat up in 2005 with new meetings of the Program Advisory and Oversight Committee. Meanwhile, the Medicare Payment Advisory Commission (MedPAC) is in the midst of announcing Medicare payment and program recommendations, among them a long awaited study on direct access to physical therapy services. O&P professionals should prepare for a busy year in Congress.
Competitive Bidding DME and “Off the Shelf” Orthotics
The Program Advisory and Oversight Committee (PAOC) for competitive bidding of Durable Medical Equipment, some orthotics, and supplies held a meeting on December 7-8, 2004, and will meet again on February 28-March 2, 2005. There appears to be consideration of inclusion of some spinal and lower limb orthoses, in competitive bidding. However, no specific codes were outlined nor was there consideration of how broad the scope of “off-the-shelf orthotics” should be set. Clearly there are many unanswered questions that remain to be answered with respect to how professional orthotic care will be impacted by the implementation process. Among topics for discussion at the next meeting are the methodology for setting payments, the bid solicitation process, small supplier issues and data collection, accreditation organizations, supplier standards, criteria for evaluating suppliers, and financial standards.
Budget Showdown on Medicare and Medicaid Cuts
Amidst growing concerns among many in Congress over a rising deficit and a looming fiscal crisis, a major battle over Medicare and Medicaid funding is likely to ensue. Though at the time of this writing President Bush has not yet released his Fiscal Year 2006 budget proposal to Congress, it is widely anticipated that a Medicaid reform package and recommendations for cuts to Medicare will be included. Republican leaders on Capitol Hill appear to be achieving consensus to cut roughly $20 billion for Medicaid and $80 billion for Medicare over the next 10 years.
MedPAC Study on Physical Therapist “Direct Access” Casts Doubt on Viability of Proposal
The Medicare Payment Advisory Commission (MedPAC) released a highly anticipated report on December 31, 2004, that casts into doubt the possibility that Congress could authorize Medicare beneficiaries’ access to physical therapists without first having to obtain a prescription from a physician. This report, ultimately, is good news for the O&P field. Because the physical therapists have made progress in the states in expanding their scope of practice to include O&P services, the elimination of the physician referral requirement at the federal level may have had the effect of permitting PTs to self-prescribe and then provide O&P care. This could have conceivably cut out O&P providers from treating large numbers of Medicare and other patients. The MedPAC report was a significant blow to the PTs’ strategy and, in this respect, represents a significant victory for the O&P field.
Written by Peter W. Thomas, Esq., NAAOP General Counsel and Dustin W.C. May, Legislative Director, Powers, Pyles, Sutter & Verville, P.C., January 24, 2005