Medicare Access to Rehabilitation Services (HR 775, S.539) (Supported by …
Medicare Access to Rehabilitation Services (HR 775, S.539)
Representative Charles Boustany (R - LA), Xavier Becerra (D-CA), Marsha Blackburn (R-TN), and Lois Capps (D-CA) proposed this bill
WHY THIS IS IMPORTANT?
Established in 1999
Limits services associated with stroke, traumatic brain injuries, or spinal cord injuries
Medicare beneficiaries are responsible for 100% of outpatient services once they exceed the cap
Cap is $1940 for OT and PT
Supported by American Physical Therapy Association (APTA)
Issued a statement in support of HR 775, S. 539
SuperPAC has gone to Washington to lobby for this bill
Eliminates the current Therapy Cap under Medicare
Addresses some of the most vulnerable under Medicare
Patients WILL NOT have to delay care
Addresses the need to choose between services
Supported by American Occupational Therapy Association, Inc.
AOTA is concerned with newly elected Congress that this will be tabled and there will no longer be a conversation about repealing
Occupational Therapist, Occupational Therapist Assistants, and Occupational Therapist students work with clients across the lifespan. Help with everyday activities
There is a lack of $$ for total funding
Concern about over utilization
Concern about potential Medicare fraud
Only received 58 votes in Congress last time it was proposed. Needs 60.
In limbo due to the recent election
This bill in one form or another has been debate over 13 times
WHY SHOULD PATIENTS HAVE TO CHOOSE?
Cost Effectiveness of HR 775, S. 539
Delaying rehabilitation services like OT results in more expensive interventions in the future
Patients have been forced to choose which services that would like to focus on - speech therapy versus occupational therapy vs physical therapy
Video through the organizational website shows the importance of supporting this bill
Focused on providing education to all of the members within the organization about why Stop the Therapy Cap should be stopped
WHAT CAN NURSING DO?
Issue a statement in support of this bill
Nursing either state or nationally (ANA for example) have not vocal on the Stop the Therapy Cap
Only nursing organization that has issued a statement in support of HR 775, S. 539 is the Skill Nursing Facilities who bill under Medicare Part B. They have been a major support REPEALING Stop the Therapy Cap.
We as nursing have not done much to provide our sister organizations, SNF.
American Nurses Association needs to issue a statement in support of the repeal.
Sometimes our approach in nursing can be "Out of Sight, Out of mind". This must be changed because we need to provide more support for other interprofessional organizations. We want our profession to be valued and cared for so we must do the same for other organizations even when not directly impacted by a particular bill.
PLAN OF ACTION
Participate in Communication about Patient Plan (CAPP) rounds which allows you to get more information and understanding of patient needs
Organizations like the ANA of state NCNA should look to highlight another profession and look at the policies that can potentially impact nursing
Nurses should the idea of care coordination which would them to have a better understanding of other interprofessional groups and their role in patient care
Make a commitment to call and write your representatives
Tell personal stories related to a family member who may have care at a nursing home but was unable to get that done due to a cap
Compare and Contrast to Nursing Profession
Nurses make up a large portion of the staff at SNFs and Comprehensive Outpatient Rehabilitation Facilities (CORF). It is important that we get involved.
When there is a lack of funding for OT, PT, and Speech pathology there will be a breakdown in the overall benefits of having the SNFs and CORF
Nurses understand the need for other services like OT, PT and Speech pathology so there has be a conversation about supporting this bill
Ambulatory services and home health also fall under the realm of STOP the CAP so HR 775, S. 539 impacts the ability to bill and have reimbursements. Thus impacting less referrals which negatively impacts patient outcomes
Part B reimburses 80% of fee screen. Additional insurance may cover the additional 20% (Medicaid)
Nurses are expected to understand documentation and typically are the main contact with the providers.
Nurses have a great understanding of treatment that would be beneficial to certain illnesses or injuries.
HR 775, S.539 is also supported by:
American Heart Association/American Stroke Association
Brain injury Association of America
National Center for Assisted
Parkinson's Action Network
United Spinal Association
References:Boustany, C. (2015, February 27). H.R.775 - 114th Congress (2015-2016): Medicare Access to Rehabilitation Services Act of 2015. Retrieved March 09, 2017, from https://www.congress.gov/bill/114th-congress/house-bill/775Federal Affairs Update March 2015: Therapy Cap. (2015, March 3). Retrieved March 02, 2017, from http://www.aota.org/Advocacy-Policy/Congressional-Affairs/Legislative-Issues-Update/2015/Federal-Affairs-Update-March-2015-Therapy-Cap.aspxGardner, K. (2017, February 2). Medicare Therapy Cap. Retrieved March 09, 2017, from http://policy.apta.org/NationalIssues/TherapyCap/Medicare Outpatient Therapy Cap. (2012, September 16). Retrieved March 04, 2017, from https://www.aota.org/-/media/Corporate/Files/ConferenceDocs/HillDay/2015/Therapy%20Cap%20Repeal%20Presentation%203-23-15.pdfMedicare Outpatient Therapy Cap. (2016, June). Retrieved March 2, 2017, from http://www.asha.org/uploadedFiles/IB-Medicare-Outpatient-Therapy-Cap.pdfNew Congress Takes First Step Toward Repealing Therapy Cap: [2/24 Update] Bill Introduced in Senate & House. (2015, February 5). Retrieved March 02, 2017, from http://www.aota.org/Advocacy-Policy/Congressional-Affairs/Legislative-Issues-Update/2015/new-congress-step-to-repeal-cap.aspxOccupational Therapy Practitioners and Hand Therapists Offer Health Care Solutions on Capitol Hill. (2016, September 19). Retrieved March 06, 2017, from http://www.aota.org/Publications-News/ForTheMedia/PressReleases/2016/091916-HillDay.aspxTHE MEDICARE ACCESS TO REHABILITATION SERVICES ACT. (2015, January). Retrieved March 1, 2017, from https://www.apta.org/PolicyResources/PositionPapers/MedicareAccesstoRehabServicesAct/