Good morning, ProviderNation.
You know by now that the doc fix victory has been deferred, even if it hasn’t exactly been denied. Provider advocates we’re talking to are still upbeat: As they see it, the Senate simply didn’t have enough time to pass a permanent fix, but there was clearly overwhelming support for it. (One super-lobbyist we talked to, a Hill veteran, said that senators have referred to the annual doc fix drama as “the paddle machine,” and they are plumb tuckered out from all the paddlin’.)
Whatever happens with the doc fix April 13, when the Senate reconvenes, an unintended consequence of the stall is that providers and families find themselves facing a paddle machine of their own. Because the doc fix legislation expired, Medicare reverted to its old, bad therapy caps, starting Wednesday, April 1. Or as AHCA/NCAL’s inestimable Dan Ciolek puts it, “it puts beneficiaries and therapy providers in a very difficult position.”
CMS has reassured government and provider types that it can belay any automatic doc fix cuts at least until April 14, the day after the Senate comes back from its Easter recess. But the agency hasn’t said what it will do about $1,940 therapy caps that are automatically resumed by the expiration of the last doc fix patch.
I’ll let Ciolek explain:
“For providers, they can either do nothing different and continue to treat beneficiaries for services above the $1,940 cap threshold, and risk not being paid if the bill does not pass, or they can decide to issue an advance beneficiary notice (ABN) to the beneficiary indicating that if Medicare does not pay for the services above the cap threshold, then the beneficiary would be responsible for payment,” he says.
He adds: “For beneficiaries, they—or their caregivers—may need to make a difficult decision whether to continue needed therapy services while hoping the bill passes and Medicare will pay, or they may decide to forgo the needed therapy services until the law is enacted due to concerns that they could not afford it.
“While this unintended consequence may be temporary,” Ciolek says, “it could have a real impact on beneficiary access to needed therapy services until the legislative delay is resolved.”
Again, most observers are optimistic that the Senate not only will pass a permanent doc fix, but will make its action retroactive, meaning the caps won’t matter. But we’ve been close before, only to see the scenery collapse. It would be a real shame if, after all this work, providers were once again asked to assume the position.