The U.S. Senate passed an
amended version of the Deficit Reduction Act (S. 1932) by a 51-50 vote.
During Senate debate, the bill was amended when Senator Conrad (D-ND) forced the
removal of three provisions which violated Senate budget reconciliation rules.
As a result of these amendments, before becoming law, the reconciliation package
will once again have to pass the House.
As the House of Representatives
recessed earlier this week, it is unclear when they will reconsider the amended
Deficit Reduction Act. At the earliest, the House could vote on the
package tomorrow. However, if a roll-call vote is required, then final
action could be delayed until next year as many members have already returned
home for the holidays.
Provisions that may have the
greatest impact on post acute care are: Medicare bad debt, the 75% Rule
regarding Inpatient Rehabilitation Facilities, Medicare Part B therapy caps,
Medicaid asset transfers, and increased flexibility for states.
Medicare Bad Debt:
The legislation keeps the allowable bad debt for dual eligible beneficiaries at
100 percent, but reduces the allowance for bad debt that is deemed
"collectable," or from individuals who are only Medicare eligible, to 70%.
75% Rule: The bill
will extend the implementation of the 75% rule by one year. Rather than
increasing IRF compliance to 65 percent on July 1, 2006, as was originally
included in the final rule, the 60 percent threshold will be extended until July
2007.
Medicare Part B Therapy
Caps: The $1,740 Part B therapy caps will go into effect on January 1,
2006. However, the legislation provides an exception process for
individuals for whom it is determined that therapy services above the cap are
medically necessary.
Medicaid Asset Transfers:
In the Deficit Reduction Act, Congress sought to slow the growth of the Medicaid
program, increase personal responsibility and give Governors more flexibility in
administering this federal/state program.
Increased Flexibility for
States: Provisions within the legislation seek to expand access to
home and community based services by allowing states to provide these services
as an optional benefit without undergoing the waiver approval process.
