Military Officer - October 2006 - (Page 36) washingtonscene contractors, one national drug contract, and two claims-processing contractors. Those program managers often find themselves competing against each other for budget dollars. Throw in a heavy dose of political budget politics, and beneficiaries often find their interests caught in the crossfire between administrators and budgeteers. MOAA and TMC are eager to participate in developing new ideas to address the challenge of rising health costs during a period of growing deficits. But part of that debate must be a clearer definition of the benefit level that military members and their families have earned through careers of arduous service and sacrifice. Clearly, we need a better handle on how and why government health delivery costs are changing and how to find appropriate ways to constrain those costs. But any such assessment also must include a fairer accounting of the cumulative premiums paid by military beneficiaries (in up-front sacrifice as well as in cash) to earn their unique military health benefits and an acknowledgement of the value their sacrifice provides for the American taxpayer. Repeal Medicare Therapy Caps ■ Visit MOAA’s Web site at http://capwiz.com /moaa/issues/bills, scroll down to Health Care Issues, and click on H.R. 916 and S. 438 to send an MOAA-suggested message to your legislators urging repeal of Medicare therapy caps. Therapy Cap Trap Don’t cap Medicare payments for therapy. A OCTOBER 2006 bipartisan effort is under way in the House to try to repeal caps on Medicare payments for outpatient therapy that otherwise will take effect in January. The Balanced Budget Act of 1997 imposed financial limitations or caps on payments for outpatient physical, speech-language, and occupational therapy services by all providers other than hospital outpatient departments. The law required a combined cap for physical therapy and speech-language pathology and a separate cap for occupational therapy. Treatments obtained through a hospital outpatient therapy department are not subject to the cap. Implementation of the $1,740 annual Medicare payment cap was delayed for several years, but it went into effect as of January 2006. The law allows an exception to the caps if such services are determined to be “medically necessary” — which most are. But this exception is due to expire at the end of 2006. This is significant because many victims of stroke and other conditions need extensive therapy that can cost far more than the arbitrary $1,740 limit. In May, Reps. Benjamin Cardin (DMd.) and Philip English (R-Pa.) authored a bipartisan letter to the chairman and ranking members of the Ways and Means Committee along with the Energy and Commerce Committee stressing the need for legislation to repeal the caps. At the very least they requested an extension of the exception process through 2007. A total of 177 representatives joined Cardin and English by signing the letter. If the authority for medical necessity exceptions isn’t renewed, TRICARE For Life (TFL) beneficiaries will be partially protected because TFL will become first payer after costs exceed the Medicare cap. But they’ll pick up some extra costs, because TRICARE annual deductibles and copayments will apply in that case. Alternatively, TFL beneficiaries can seek these services through a hospital outpatient therapy department. MO — Contributors are Col. Steve Strobridge, USAF-Ret., director; Col. Mike Hayden, USAFRet.; Col. Bob Norton, USA-Ret.; Cmdr. René Campos, USN-Ret.; Cmdr. John Class, USN-Ret.; Cass Vreeland; and Bret Shea, MOAA’s Government Relations Department. 36 MILITARY OFFICER http://capwiz.com/moaa/issues/bills http://capwiz.com/moaa/issues/bills
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