[Congressional Record Volume 144, Number 60 (Wednesday, May 13, 1998)]
[Extensions of Remarks]
[Pages E853-E854]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


   INTRODUCTION OF THE REINSTATEMENT OF REHABILITATION BENEFITS FOR 
                              SENIORS ACT

                                 ______
                                 

                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                        Wednesday, May 13, 1998

  Mr. CARDIN. Mr. Speaker, I rise in support of important legislation 
for Medicare beneficiaries who require outpatient therapy, the 
Reinstatement of Rehabilitation Benefits for Seniors Act. This bill 
repeals the Balanced Budget Act provision that imposes an arbitrary cap 
on outpatient physical therapy, occupational therapy, and speech-
language pathology services as of January 1, 1999.
  Section 4541(c) of the Balanced Budget Act places annual caps of 
$1,500 per beneficiary on all outpatient rehabilitation services except 
those furnished in a hospital outpatient department. I am deeply 
concerned about the impact this limitation will have on Medicare 
beneficiaries who require necessary rehabilitation services.
  If this cap is implemented, senior citizens suffering from medical 
conditions common to the elderly such as stroke, hip fracture, and 
coronary artery disease will have diminished access to rehabilitation 
care they require to resume normal activities of daily living.
  The $1,500 cap is arbitrary and, according to BBA, cannot be adjusted 
for the medical condition of the patient, or the health outcomes of the 
rehabilitation services. These caps are, by definition, insensitive to 
patients suffering from diseases or chronic injuries or who have 
multiple episodes of care in a given calendar year.
  The $1,500 cap dramatically reduces Medicare beneficiaries' choice of 
provider. Congress has committed to offering beneficiaries greater 
health care choices. However, a senior citizen who has met the $1,500 
cap will have no choice but to seek care in a hospital outpatient 
department. More convenient provider choices such a rehabilitation 
agencies, physical therapists in independent practice, and 
Comprehensive Outpatient Rehabilitation Facilities will be foreclosed 
to them. Beneficiaries in rural areas will have a particularly 
difficult time obtaining needed services.
  Furthermore, absolute dollar limitations on outpatient rehabilitation 
services are unnecessary. Effective January 1, 1999, the same date the 
$1,500 cap goes into place, all outpatient rehabilitation services will 
be reimbursed according to a fee schedule based upon the Resource Based 
Relative Value Scale (RBRVS). The movement from cost-based 
reimbursement to a fee schedule obviates the need for an arbitrary 
fixed dollar limit on beneficiary services. The screens and edits 
within the existing fee schedule are designed to control utilization of 
services.
  Confusion has surrounded the interpretation of how the $1,500 cap is 
to be applied. While the $900 cap that exists for physical therapists 
and occupational therapists in independent practice today applies 
separately to both physical therapy and occupational therapy, 
discussions with HCFA indicate the $1,500 cap may be applied 
differently. HCFA has indicated the new provision of law could be 
interpreted as establishing two separate caps. The first cap of $1,500 
would be for occupational therapy services, while the second cap would 
be split between physical therapy and speech-language pathology. 
Speech-language pathology is not currently capped in outpatient 
settings.
  Finally, Congress held no hearings on the imposition of an arbitrary 
cap prior to adopting this provision last year. As a result, we have 
been unable to consider the potential problems that may arise with 
implementation. In comparison, multiple hearings were held on new 
payment mechanisms for skilled nursing facilities, home health 
agencies, and managed care plans.

[[Page E854]]

  Passage of the Reinstatement of Rehabilitation Benefits for Seniors 
Act, which I am proud to cosponsor, is necessary to ensure that seniors 
have sufficient access to necessary physical therapy, occupational 
therapy, and speech-language pathology services under Medicare. I am 
proud to say that this bill is also fiscally responsible, requiring the 
Secretary of Health and Human Services to implement a new methodology 
for payment of rehabilitation services by January 1, 2000, to ensure 
budget neutrality. I urge my colleagues to cosponsor this important 
legislation.

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