Federal Focus - December 2010

Medicare Reimbursement and Therapy Caps Temporarily Addressed

This week, Congress passed the Medicare and Medicaid Extenders Act of 2010. This bill will temporarily preserve Medicare reimbursement rates for physicians and protect Medicare beneficiaries’ access to Medicare physical therapy, occupational therapy, and speech language pathology for the next several months.

Currently, the Medicare program covers an estimated 47 million people, including 8 million people with disabilities who are under age 65. Nearly one-quarter of those living with MS rely on Medicare as their primary type of insurance. The sustainable growth rate (SGR) is a major component of Medicare’s current payment formula that determines annual updates and has the potential to drastically cut Medicare physician reimbursement rates, threatening access to services. Because of the negative real world impact, Congress has deferred the cuts several times—the last time delaying the cuts through December 31, 2010. The recently passed Medicare and Medicaid Extenders Act blocks a scheduled 25 percent cut that would have taken effect on January 1, 2011 and protects reimbursement through December 31, 2011.

The legislation also extends through December 31, 2011 the exceptions process for outpatient Medicare therapy caps. An arbitrary limit, the Medicare therapy cap places a combined limit of $1,860 on physical therapy and speech language pathology services and a separate $1,860 limit for occupational therapy services. In 2006, Congress authorized the Centers for Medicare and Medicaid Services (CMS) to create an exceptions process, whereby individuals can continue to access medically necessary physical therapy, occupational therapy, and speech language pathology services above cap levels as long as services met specified diagnostic and clinical criteria. The exceptions process has been extended several times and the Medicare and Medicaid Extenders Act of 2010 will continue to protect access to therapy services through December 31, 2011.

111th Congress Winds Down Without a Senate Vote on MS Registry Bill

With the lame duck session of Congress coming to an expected close by the end of next week, the Society is disappointed that the Senate has not taken up and voted on the National Neurological Disease Surveillance System Act (H.R.1362) to date. With limited time and over 400 House-passed bills awaiting a Senate vote, it seems there is little opportunity for our bill to make it to the Senate floor this session of Congress. While the prospects seem slim, it is not for a lack of passion or effort on behalf of our activists! The activists involved in this effort have been relentless in trying to move this forward and see this enacted and we are so thankful for all of their help and inspiration!

Federal Appropriations Being Determined for Fiscal Year 2011

The federal government has been operating under a Continuing Resolution (CR) that largely maintains current funding for federal departments and programs at fiscal year (FY) 2010 levels. This week, the House approved a longer term continuing resolution that will continue to freeze FY 2011 spending for the remainder of the fiscal year at FY 2010 levels.

Senate Democrats plan to try to substitute an omnibus bill that includes text from unfinished appropriations measures that alters some funding levels. Approved but unfinished appropriations measures have included significant increases for two programs important to people living with MS--MS research in the Congressionally Directed Medical Research Programs (CDMRP) and the Lifespan Respite Care Program. The Society recently sent a letter requesting that Congress maintain these increases for MS research in the CDMRP and the Lifespan Respite Care Program. At press time, the Senate had not yet acted on the Continuing Resolution.

In total, the Continuing Resolution provides $170.27 billion for programs under the jurisdiction of Labor, Health and Human Services, and Education. Many health-related programs important to people living with MS including Medicare, Medicaid, and the National Institutes of Health fall under this category. While most programs remained the same under this agreement, there was one notable addition to the Continuing Resolution--addition of funding for the Cures Acceleration Network. This program was created under the Affordable Care Act and has been supported by the Society because of its focus on improving the translation of medical research advances into new drugs and therapies.

Happy Holidays from the National MS Society

As we celebrate the holiday season, the National MS Society would like to thank its nationwide network of passionate MS activists for their commitment and continuous advocacy for federal, state, and local policies that will improve the lives of people of people living with and affected by MS. Despite another difficult budget year, MS activists boldly championed requests for increases in funding for MS research in the Congressionally Directed Medical Research Programs (CDMRP), the National Institutes of Health and for family caregivers through the Lifespan Respite Care Program. We also passed legislation in the U.S. House of Representatives (but not yet the Senate) that would create nationwide multiple sclerosis (MS) and Parkinson’s Disease surveillance systems, providing important data that could help uncover and inform promising areas of MS research and support the discovery of disease therapies, treatments, and one day—a cure.

Significant momentum was gained on new legislation that would allow Medicare to cover off label prescription drugs for people with MS and other chronic diseases. MS activists also advocated for introduction of a bill to provide federal funding for the establishment and enhancement of adult day achievement centers for people with MS and other similar chronic diseases. In addition to presenting at various Congressional briefings on Capitol Hill this year that brought attention to our issues, MS Activists helped ensure the passage of the formal Congressional recognition of MS Awareness Week.

In 2010, MS activists sent over 45,000 messages to Capitol Hill. Each one of these is vitally important and is an instrumental step moving us closer to a world free of MS. Thanks to your efforts, we are making considerable progress and laying valuable groundwork for the future. The National MS Society thanks you for your activism and wishes you a happy and healthy holiday season.





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