[Congressional Record Volume 161, Number 53 (Tuesday, April 14, 2015)]
[Senate]
[Pages S2154-S2155]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            SGR LEGISLATION

  Mr. CARDIN. Mr. President, I am hopeful--and most of us are--that 
soon we will be able to consider Medicare legislation that has passed 
the House of Representatives. It is probably best known as the SGR 
permanent fix.
  The SGR, which is a payment system that affects physicians under the 
Medicare system, is badly broken. On 17 previous occasions we have 
extended the current policy in order to make sure that physicians don't 
get an automatic cut that would deny many Medicare beneficiaries access 
to their physicians. These are pretty extreme measures.
  We all understand that it is time to permanently fix this--not just 
to eliminate the problem but to substitute a payment system that 
encourages physicians to provide high quality care and to deal with 
incentives that reduce the volume of care. And that is what the 
legislation that passed the House of Representatives does.
  It fixes the problem on a permanent basis. I am certainly hopeful we 
can get that enacted shortly because it already passed the deadline in 
regard to when the current patch expired. The bill also provides for an 
extension for the Children's Health Insurance Program. I do hope we can 
provide a longer extension than the 2 years that is provided in the 
House bill. I know there will be amendments offered to deal with that.
  I want to talk about an amendment I will be offering. I am not sure 
how much time will be available when a consent arrangement is entered 
into--which I hope will be soon--to consider this. It is an amendment I 
am offering with Senator Vitter. It is a bipartisan amendment. In 
previous Congresses, we have had many of my Republican colleagues who 
have joined me, we have had many of my Democratic colleagues. This 
should be, I hope, a noncontroversial amendment we can adopt.
  What it does is provide a permanent fix, as we do for physicians, for 
the physical therapy cap. I was in the House of Representatives in 1997 
when we passed the Balanced Budget Act of 1997. I was on the Ways and 
Means Committee. I remember a chairman's mark coming to us. For the 
first time there was a cap placed on physical therapy services.
  I asked the chairman of the committee why was this being done. There 
was absolutely no policy reason whatsoever for imposing an arbitrary 
cap on the amount of physical therapy services. When you think about 
it, what it does is discriminate against those who have the greatest 
needs, those who have severe needs, those who have a stroke or 
traumatic brain injury or a spinal cord injury or managing Parkinson's 
disease, multiple sclerosis, arthritis.
  These are the individuals who run up against the cap and therefore 
could be denied the ability to deal with their needs, causing them, in 
many cases, to incur much greater costs. It makes no sense whatsoever, 
the therapy cap.
  For that reason, on a pretty regular basis, we have extended the 
revised policy. Twelve times we have done it to prevent the 
implementation of the therapy cap. We have acknowledged the negative 
consequences that would result from the imposition of such limits. In 
2009, a report issued by the Medicare Payment Advisory Committee, 
MEDPAC, it was estimated that the therapy cap, if enforced without an 
exception process, could harm 931,000 Medicare beneficiaries.
  So we have an identical situation on the therapy cap as we do with 
the SGR physician reimbursement issue. That is why historically these 
two measures have always been moved together in tandem. What my 
amendment will do, cosponsored by Senator Vitter, is permanently fix 
the therapy cap issue by replacing the arbitrary limits on outpatient 
rehab therapy services with a more rational system which will require 
prior authorizations in certain circumstances.
  So we fix it permanently, as we do the physicians' reimbursement 
issue. I do not need to tell the Presiding Officer that we do not 
always have an opportunity to get legislation done here. I do think we 
have a chance--an excellent chance--that this bill we will be taking up 
is going to be signed by the President in the next few days.
  This is our opportunity to get several matters taken care of. The 
therapy cap cries out for that type of attention. So I would urge my 
colleagues, when this amendment comes up--it is cosponsored by a large 
number of my colleagues. As I already mentioned, Senator Vitter, who is 
my cosponsor. On the Democratic side, we have both Senator Reid and 
Senator Reed, Senator Whitehouse, Senator Hirono, Senator Casey, 
Senator Shaheen, Senator Menendez, Senator Mikulski, Senator Brown, 
Senator Stabenow, Senator Leahy, Senator Cantwell, Senator Bennet, 
Senator Booker.
  I could mention many of my Republican colleagues who have joined me 
in the past in the repeal of the therapy

[[Page S2155]]

cap that are expressing an interest to help in this regard. I hope I 
will have their support on this amendment. Let's get it done. I think 
it is important for Medicare beneficiaries to know they are not at risk 
of losing the opportunity for their physician to treat them under the 
Medicare system.
  If we do not take care of the SGR problem, that is a real, real 
concern of Medicare beneficiaries, as to whether their physicians will 
be available for them. The same thing is true with the therapy cap. 
Let's remove this uncertainty. Let's get it fixed. We have the 
opportunity to do that. So I would urge my colleagues to support my 
efforts that are supported by AARP and many of the outside groups.
  Let's vote for the SGR bill but also vote for the amendment I will 
offer with Senator Vitter that will permanently fix the therapy cap. We 
will have a chance to do that I hope either later tonight or tomorrow.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. CARPER. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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