Home Health & Hospice Week

The House and Senate 2010 budget resolutions may not currently contain any proposed home care reductions, but the industry isn't banking on that to keep cuts off the budget chopping block all year.

The House and Senate must work out a single budget resolution to pass, which is expected to happen by the end of the month or so. Then that resolution is merely a blueprint for the real budget negotiations that will take place throughout this year's session.

In a surprising move, the Senate approved an amendment from Sens. Ben Cardin (D-Md.) and John Ensign (R-Nev.) that "would create a reserve fund making it easier to ultimately eliminate the arbitrary caps on Medicare outpatient rehabilitation therapy services performed outside a hospital setting," according to Cardin. "The caps were first enacted in 1997," he notes in a release.

In home care, the $1,840 caps apply only to outpatient therapy furnished by home health agencies under Part B, not therapy under a home health plan of care.

What this means: The amendment acknowledges that the reserve fund, which is aimed at addressing health care reform and the physician payment fix, could be used for repealing or addressing the therapy caps, explains Kelly Lavin of the American Physical Therapy Association.

A repeal of the caps is now much more hopeful, but it'll still take some work. For starters, the amendment was not introduced on the House side, Lavin points out.

The bright side: "Most of the bills that have been passed into law this year are the Senate version," Lavin says. "So we're quite hopeful." In addition, "The significance of this is symbolically important," APTA says. "It directs other Senate committees, such as the Senate Finance Committee, to focus on ... the therapy caps in its legislative work this year."

Another hurdle: Budget resolutions are non-binding, so it's not a done deal that the funds will go toward a therapy cap repeal, points out Tim Nanof of the American Occupational Therapy Association. The amendment simply acknowledges that the therapy caps are an important issue and that there is money in the reserve fund that could be used to address this problem, he explains. "Congress will still have to pass legislation to address the cap."

At least the amendment "does place a higher priority on addressing the therapy cap issue," says the American Speech-Language Hearing Association.

"This is our 10th year anniversary of the therapy caps, so hopefully it's about time that we have the issue solved once and for all," Lavin adds.

Do this: While Congress irons out this legislation,providers should continue to support S. 46 and H.R. 43, legislation that would repeal the Part B therapy caps, ASHA recommends. The current therapy cap exceptions process will expire on Dec. 31, 2009 without further congressional action.