Washington, D.C.  -In the final days of the first session of the 110th Congress, the U.S. House of Representatives moved to pass bipartisan legislation that will extend critical healthcare programs for children and seniors.  U.S. Rep. Phil English (R-Pa.) championed several of the key provisions included in S. 2499, the Medicare, Medicaid and SCHIP Extension Act of 2007, which passed the House floor today by a vote of 411 to 3.

“Today, the House acted on critical, bipartisan legislation that will ensure both kids and seniors have continued access to the critical healthcare programs they need and depend on,” said English a senior member on the House Ways and Means Health Subcommittee.  “While I would have preferred a bill that provided permanent solutions to improving SCHIP and enhancing Medicare programs, this legislation will ensure uninterrupted access to quality and affordable healthcare for kids and seniors across the country.”

SCHIP provides healthcare coverage to American children whose parents do not qualify for Medicaid, but can’t afford private health insurance. English, a longtime champion of the program, has supported legislation to strengthen and expand the program. S. 2499 would extend SCHIP for an additional 15 months, through 2009. 

“By extending the SCHIP program we will ensure that even the neediest children can get the care they need to improve their health and quality of life throughout next year,” English said. “Additionally, this measure will provide important healthcare reforms that will enhance the Medicare program and ensure our seniors have access to necessary therapy services.” 

English has been a leading advocate of the modernization of Medicare, working to ensure patients have access to essential services and that physicians are fairly reimbursed for providing care to Medicare beneficiaries. The Medicare, Medicaid and SCHIP Extension Act of 2007 included critical provisions that will update payments for physicians and address the cap on therapy services under Medicare.
 
Therapy Cap
Specifically, S. 2499 included an English provision to address the cap on therapy services under Medicare. The Balanced Budget Act (BBA) of 1997 imposed annual caps per beneficiary of $1,500 on occupational therapy and a separate combined $1,500 cap on physical therapy and speech-language pathology under Medicare Part B.  Since then, Congress has acted three times to place a moratorium on the therapy caps. On January 1, 2006, a cap of $1,740 (adjusted for inflation) went into effect for these health care services.  In response, Congress provided beneficiaries with a clinically based exceptions process to the financial limitation on rehabilitation services under Medicare. 

To date, the exceptions process has served as a mostly acceptable alternative to ensure seniors have access to all necessary services.  However, without congressional action, the current exceptions process will expire December 31, 2007.  S. 2499 would extend the exceptions process for an additional 6 months, providing the Centers for Medicare and Medicaid Services (CMS) and Congress time to establish an effective and permanent solution.

 “Whether a person receives speech, occupational or physical therapy, it should be a decision made between a doctor and a patient, not by accountants monitoring a set limit,” said English, who has championed efforts in to permanently repeal the caps on rehabilitative therapy under Medicare for the past three Congresses.  “By extending the current exceptions process we will ensure seniors’ rehabilitative needs will be met without limiting care to an arbitrary price tag.”

Long-Term Care Hospitals
S. 2499 included an English provision to take steps to protect access to long-term care hospitals.

Long-Term Care Hospitals (LTCHs) provide care to patients with complex medical conditions who require hospital care for an extended period of time.  LTCHs play an important role in the continuum of care by treating patients who are well enough or no longer need intensive care, but still too sick to go to a skilled nursing facility.  However, concerns have been raised that some LTCHs are admitting patients that may be better served by nursing homes, and as a result, limiting access to patients depending on the services provided by these specialized hospitals.

S. 2499 would correct this inequity by defining the appropriate role of LTCHs in the continuum of care while also ensuring regulatory stability and continued access to care.  This provision mirrors legislation that English introduced this year along with U.S. Rep. Earl Pomeroy (D-ND), H.R. 3057, the Medicare Long-Term Safety and Improvement Act.

Sustainable Growth Rate
Medicare currently uses the Sustainable Growth Rate (SGR) to calculate physician payment updates.  Beginning in 2004, the first year the SGR yielded a negative payment update, Congress implemented stopgap measures to ensure that physicians receive a positive reimbursement rate while the costs associated with delivering care have increased.

Today’s House passed measure would prevent physician payment cuts in 2008 by providing a six month 0.5 percent increase in payment rates for physician services; averting approximately a 10 percent cut in physician reimbursements for providing care to Medicare beneficiaries in 2008.

“Recognizing the staggering negative impact the current system of physician reimbursement could have on both Medicare providers and beneficiaries in western Pennsylvania, I will continue to fight to fix the underlying problem: the broken SGR formula,” English said.  “By implementing a temporary payment increase, Congress will now have to act quickly and develop a permanent solution that will yield fair reimbursement updates for physicians.”     

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