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Congress Must Take Immediate Action on Behalf of Medicare Consumers

-- Deep Cuts to Medicare Physician Payments Will Take Effect December 1

New York, NY, November 15, 2010 – Congress still has important business to do on behalf of people with Medicare by the end of this year, declares the Medicare Rights Center in a letter sent to the Congressional leadership on November 12. Congress must pass legislation that will avert payment cuts to Medicare physicians, which are due to go into effect next month, renew the Qualified Individual (QI) program and extend the therapy caps exceptions process, according to the letter.

“There have been major victories for people with Medicare in 2010, including the start of closing the coverage gap in the Medicare prescription drug benefit, among other improvements to the program,” said Joe Baker, president of the Medicare Rights Center.

 “However, the 111^th Congress still has work to complete in order to ensure people with Medicare can access medically necessary care in 2011.”

The letter addresses the need for Congress to take immediate action to avert a pending 21 percent cut in Medicare physician payment rates, due to take place on December 1, and an additional four percent cut that is due to take effect on January 1, 2011.

“This cut in provider payments, due to the Sustainable Growth Rate (SGR) formula [passed in 1997] is a source of great anxiety for the Medicare population, some of whom are hearing from their physicians that if the cuts take effect, they will no longer see Medicare patients,” wrote Baker.

“While a long-term solution is ideal, as it would create greater stability in the system for both patients and providers, a plan that prevents reductions for an extended period would at least provide further opportunity to evaluate the current SGR system while also protecting Medicare consumers’ relationships with their physicians.”    

In order to prevent an interruption in benefits, Congress must also pass legislation by the end of the year to extend the QI program and the Medicare therapy caps exceptions process, both set to expire on December 31, 2010.  

Administered as a federal block grant to states, the QI program helps those with limited means afford health care by paying the Part B premiums of low-income Medicare consumers with income between 120 and 135 percent of the Federal Poverty Level (FPL). 

“In this time of economic uncertainty, it is imperative that steps are taken to protect low-income people with Medicare from additional financial burdens,” Baker wrote in the November 11 letter.

“The QI benefit creates greater financial security for these Medicare consumers, allowing them to use the money they save on premiums for other basic living necessities. . . . Extending QI now will help cash-strapped states plan their budgets and avoid disruptions in coverage.”

Also set to expire at the end of the year is the Medicare therapy caps exceptions process.

The exceptions process to limitations on Medicare payment for physical, speech and occupational therapy allows consumers who reach the cap, set at $1860 for combined speech and physical therapy services and $1860 for occupational therapy services, to obtain continued coverage of medically necessary services.