Posted on July 16, 2008

By overwhelming margins Tuesday both houses of Congress voted to override President Bush's veto of the Medicare Improvements for Patients and Providers Act of 2007 (HR 6331), to restore a 10.6 percent cut to the Physicians' Fee Schedule that took effect July 1, and extend exceptions to the Medicare therapy cap for 18 months.

The override also delays implementation of a competitive bidding program for suppliers of durable medical equipment, including orthotics and prosthetics (DMEPOS). It will bring parity for mental health treatment to within 20 percent of physical treatment over a specified period of time.

The House vote was 383-41, easily more than the two-thirds majority required for the override; the Senate agreed, 70-26. This is Congress' first override of major legislation vetoed by Bush administration.

The president said he agreed with the intent of the legislation, but not with its financing plan, which will cut the government's subsidizing of Medicare Advantage private pay plans for senior citizens. At issue was how many seniors will be using such plans by 2013. The administration estimates the number at 14.3 million; Congress puts it at 12 million.

The veto is the best news of the year for occupational therapists. In fact, according to an Associated Press report, "virtually every type of health care provider as well as millions of patients have a stake in the legislation."

Therapy reimbursement in Medicare is based on the fee schedule, so not only did therapists fear the fallout from a lack of adjustment to the therapy caps ($1,810 annually for occupational therapy, and the same amount to be split between physical therapy and speech-language pathology), but a cut in general reimbursement was imminent.

In anticipation of an expected override, CMS has been holding therapy claims since July 1, when the cap went into effect fully. It is now expected to start processing them immediately. According to AOTA, "the bill also provides increased incentives for Physician Quality Reporting initiates for 2009 to 2011 and requires CMS to develop profession-specific accreditation standards for DMEPOS or allows [HHS] to defer to state regulations."

There is already a CMS-approved facility accreditation program for DMEPOS suppliers and providers, the National Board of Accreditation for Orthotic Suppliers (NBAOS), incorporated in 2006 (see this week's cover story).

As an incentive to get Medicare patients to enroll in Medicare Advantage privately-paid plans, the Bush administration has been spending more money to undergird and subsidize those plans than it does for regular Medicare beneficiaries. According to the Associated Press, the new legislation will lower co-payments for mental health treatment and allow more people to qualify for government subsidies to their monthly premiums.

"Prior to Bush's veto, the House had voted in favor of the bill 355-59, so Tuesday's override vote showed more Republicans breaking with the administration," the AP reported. "The vote in the Senate in passing the bill was much closer, 69-30, leaving little margin for error for supporters trying to sustain a two-thirds majority to override."

E.J. Brown is editor of ADVANCE.