Dec. 8, 2021 (updated Feb. 16, 2022): An intense advocacy effort fueled by APTA members and a long list of other professional organizations has earned a win: On Dec. 7, the U.S. House of Representatives passed legislation that offsets most of the proposed cut to the 2022 Medicare Physician Fee Schedule's conversion factor and delays additional reductions that were looming due to sequestration and other budget requirements. Without congressional action, PTs and some three dozen other health professions were facing cuts under the fee schedule in addition to across-the-board reductions totaling an additional 6%.
The legislation will now be taken up by the U.S. Senate, where it's expected to pass, thanks in part to its connection to an agreement around Senate procedures related to debate on the U.S. debt ceiling.
"The legislation approved by the House is a major step forward in buffering some of the worst impacts of the Medicare cuts planned for 2022," said David Scala, APTA senior congressional affairs specialist. "There's strong support for the fixes in the Senate and some additional motivation for approval of the bill, so the momentum is definitely there for some type of relief to make it into law."
"Again this year, we've seen the power of member advocacy," said Laura Keivel, APTA grassroots affairs and political affairs specialist. "APTA members and their supporters committed themselves to seeing to it that legislators and policymakers understand the potential damage of the cuts envisioned by the Centers for Medicare & Medicaid Services, including sending more than 15,000 letters to lawmakers in just the past week. Their hard work is paying off, and we have just one more hurdle to go."
What the House Passed
The Medicare-related legislation, doesn't do everything APTA and other organizations have asked for, but it comes close. Here's what's in the bill.
An infusion of new funding to (mostly) offset planned payment cuts.
As in 2020, CMS in 2021 proceeded full-stem-ahead with a policy that resulted in a cut to the conversion factor that is used to set payment for codes used by providers under the fee schedule. Last year Congress intervened and provided $3 billion in new funding to the fee schedule that boosted the conversion factor by 3.75%; however, that funding was good only through 2021. With the new legislation, more money would again be appropriated to CMS to offset the fee schedule cuts — this time the funds will provide a 3% increase to the conversion factor.
Delayed, then phased-in return of sequestration.
In the midst of the pandemic last year, Congress put the 2% sequestration cut on hold for 2021 to temporarily boost payment to providers as part of their pandemic relief package known as the Cares Act. In 2022, this payment boost will be phased out and sequestration will return, but not until April. At that point, a 1% sequestration will be imposed until June 30, 2022, with the required 2% sequestration returning in July and remaining until the sequestration system expires in 2031. The 2% sequestration was mandated as part of the 2011 Budget Control Act and has been a regular feature of Medicare budgets since 2013.
A plan for averting "PAYGO" cuts.
On top of the 2% sequestration and 3.75% cut, Medicare was also facing a 4% reduction to comply with federally mandated "pay-as-you-go" deficit control budget rules requiring that increases in the federal deficit be offset by increased revenue or cuts to spending. The legislation approved by the House delays implementation of the PAYGO cut until 2023.
A tie-in to more good-news legislation — and a filibuster workaround.
The Medicare-related legislation passed by the House is folded into another piece of legislation, legislation, the Dr. Laura Breen Health Care Providers Protection Act, an APTA-supported bill that is focused on preventing and addressing health care provider burnout and positive mental health. The Breen bill includes training grants, funding for awareness campaigns, and money for treatment, among other provisions, and has already passed the Senate. The Senate's version was sent to the House earlier this year, where its Rules Committee tacked on the Medicare package. (Note: Subsequent to publication of this article on Dec. 8, 2021, APTA learned that the Senate removed the Laura Breen Act language from the final version of the bill, which was signed into law. At the time of this update on Feb. 16, 2022, the Senate is expected to pass the Dr. Lorna Breen Act in 2022. The legislation has already passed in the House.)
The bill approved by the House also includes a key measure related to the current debate over raising the nation's debt ceiling: a provision that limits debate on the issue to 10 hours, effectively shutting down the possibility of filibuster, and opening the possibility for a simple majority vote in the Senate on the debt ceiling. Because Senate Republican leaders have already signaled their support for limiting debate on the ceiling, inclusion of the time limit in the Medicare fix bill could help ensure its passage in the Senate.
The Senate Path
While the House passed the Medicare changes as standalone legislation, the journey the changes will take in the Senate is a little trickier— which could be a good thing. (This is where staying awake in civics class pays off.)
Because the House essentially amended the Breen Act passed in the Senate when it folded its Medicare fixes into the bill, the new package now has to return to the Senate for its final approval. The bill still features the same number — S.610 — but now it's called the "Protect Medicare and American Farmers from Sequester Act." It also includes the debt ceiling debate limit mentioned above, which some observers believe could help its chances of being passed.
No Guarantees
As with all machinations on Capitol Hill, there's never a sure bet. That's why we need to be ready to advocate for S.610. Stay tuned to APTA — by way of our website, member emails, social media, and the APTA Advocacy Network — for calls to action in the coming days.