Advocacy - Legislation

NARA Legislative Priorities

• Repeal of the Medicare Therapy Caps - NARA supports repeal of the arbitrary caps on physical therapy, speech therapy and occupational therapy services that was enacted as a part of the Balanced Budget Act of 1997.  Congress has provided   short term solutions in dealing with the cap since 2002.  It is time to establish a long term solution through a repeal of the cap or development of an acceptable payment methodology.  The current exceptions process will expire December 31, 2010.  If Congress does not intervene, the exceptions process will disappear, with devastating consequences to Medicare beneficiaries who will be denied care. NARA members are strongly encouraged to contact your member of Congress and ask them to either repeal the therapy cap approve an alternative payment or provide a continuation of the exceptions process.
  
  
• Fixing The Physician Fee Schedule - NARA believes that it is crucial to correct the scheduled 21.4% cut to the physician fee schedule in 2010. Medicare projects cuts to the physician fee schedule for several years to come. This issue is important to rehab agencies because the fee schedules for physical, occupational, and speech therapy are included in the physician fee schedule. NARA advocates the abolition of the cuts, but feels that Congress must rectify the underlying problem in the methodology behind the physician fee schedule. Congress must correct the sustainable growth rate assumptions that help determine the physician fee schedule. Legislation is now being introduced to correct this issue. NARA will update you when more information becomes available.
  
  
• Increased Regulation of Physician Self-Referral Practices - Physician Self-Referral Practices have sprung up all over America due to changes in the Stark regulations. Physicians are now employing physical therapists and making referrals exclusively to these employees. NARA believes these practices have a significant potential for over utilization of physical therapy services. Studies have shown that physician ownership of laboratories and specialty hospitals resulted in over utilization of these services when the physician had a financial interest in them. Many believe the recent increase in physical therapy services under Medicare is due the proliferation of Physician Self-Referral Practices. NARA supports Congressional legislation and Medicare regulations that will curb the financial benefits associated with Physician Self-Referral.
  
  
• Critical Shortage of Qualified Rehabilitation Professionals - The National Association of Rehab Providers and Agencies (NARA) has added as a legislative priority the issue of the critical shortage of qualified rehabilitation professionals (Physical Therapists and Assistants, Occupational Therapists and Assistants, and Speech Language Pathologists) to meet the current demands of the physicians and patients for our services.  We believe that this shortage is due to the following factors:
  
  1. Difficulty since 9/11 bringing into the United States qualified professionals from other countries
  2. A decline in students graduating each year from accredited Universities since the year 2000.  Although there has been a slight increase in 2006,  student enrollments have declined and there are not enough new graduates to fill the demand for service (Info from a University of Illinois study)
  3. The aging population coupled with technology in orthopedic surgery and longer life spans has increased the demand for service as people want to be active and independent as long as possible
  4. Children surviving premature births who often have developmental delays, and other physical defects requiring intense early intervention services by qualified rehab professionals
  5. The current shortage of staff not only has a negative impact on our ability to provide service to individuals in need, but the short supply has also created higher wages and benefits which has increased the cost of our service to our patients, and ultimately to all third party payers.
  
  NARA sees this shortage as critical as the shortage of nurses in our country, and urges Congress to review this matter, and assist through the following initiatives:
  
  1. Ability to bring in qualified rehab professionals from other countries more readily
  2. Provide incentives (through scholarships and  low cost loans) to prospective qualified high school graduates who choose to enter a rehabilitation field

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