JANUARY 2012

Medicare Therapy Caps Exception Process Only Extended
Through February

In a last-minute deal, Congress extended the Medicare therapy caps exceptions process through February 29, 2012. That means stroke survivors covered by Medicare will be able to obtain non-hospital, outpatient rehabilitation therapy services above the annual caps if that therapy is considered medically necessary by a healthcare provider—but only until February 29. This deal also extended the payroll tax cut and prevented a nearly 30 percent cut in physician Medicare reimbursement through that date.

Congress now has until the end of February to strike a longer-term deal that preserves the exceptions process for Medicare therapy services beyond February 29. If Congress fails to approve a longer-term extension, patients who reach the caps and require more therapy will have to make the difficult decision to either forego treatment or pay out of pocket. It would also be the first time since Congress established the exceptions process in 2006 that is has been allowed to expire.

The caps on therapy services were originally implemented by Congress in an attempt to control Medicare spending. The exceptions process was created to enable people with significant therapy needs who reach the annual caps to receive additional therapy if those services are determined to be medically necessary. While only a portion of stroke survivors covered by Medicare require services above the caps, those who do are among the most severely affected by stroke. National Stroke Association believes that all stroke survivors deserve access to enough therapy services to recover to their fullest potential.

Your voice has been thunderous on this issue. Since early December, over 1,700 advocates have sent nearly 7,000 messages to Congress in support of the exceptions process. If you’re not one of them, join the Stroke Advocacy Network today. Become a stroke advocate and make your voice heard on this critical issue.

If you’ve already contacted your members of Congress about it, please do it again. Your help is still needed to ensure that stroke survivors covered by Medicare have access to an adequate amount of therapy services after February 29. Let your member of Congress know that you support the Medicare therapy caps exception process.

What’s Happening in Your State Legislature?

The Stroke Advocacy Network has launched the State Advocacy Action Center. The Center houses information about stroke-related legislation being considered by state legislatures across the country.

We need your help to identify this legislation. As you go about your daily life—reading and watching local news and talking to people in your community—write down any information about stroke-related policies being considered by your state legislature. Send that information to us, and we’ll post it on the State Advocacy Action Center. We’ll also spread the word to other Stroke Advocacy Network members in your state and provide tools to help them communicate with their state legislators on this issue.

The Stroke Advocacy Network has made its voice heard in the nation’s capital—making a difference for the stroke community. Now it’s time to make that voice heard in state capitals across the country—to make sure legislators in your state understand stroke and vote for policies that prevent stroke and improve the lives of stroke survivors, caregivers and their families.

NIH Funding Increased in FY 2012

In a budget package that funds the federal government through September 2012, Congress increased National Institutes of Health (NIH) funding by $300 million over last fiscal year. The NIH is set to receive a total of $30.7 billion for its medical research activities. This includes $1.6 billion specifically designated for the National Institutes of Neurological Disorders and Stroke (NINDS), the federal government’s primary medical research agency for stroke. This increase in NIH funding comes as a welcome surprise in a budget year when many other programs saw drastic cuts.

The Stroke Advocacy Network made NIH funding a priority in 2011. Network members sent over 1,000 messages to members of Congress asking them support NIH funding. The deal that increased the agency’s funding for the 2012 fiscal year (FY 2012) was reached shortly before Congress adjourned for the holidays, narrowly avoiding a government shutdown.

Though the budget for FY 2012 was just finalized, efforts to sustain funding for the NIH in FY 2013 are already underway. The budget process begins early, with President Obama outlining his general goals for the year in his State of the Union Address in late January. In early February, the President typically submits a budget to Congress outlining recommended funding levels for all federal agencies. Congress then begins the process of developing and passing its own budget. It’s likely that pressure to reduce government spending will continue this year, and that pressure will expand to programs that were spared cuts this year.

Stroke-Related Legislation in Congress: Updates

The New Year might be a time for new beginnings for some, but for Congress, it’s just more of the same. That’s because Congress divides its work into two-year intervals, called terms. Congress is currently in the middle of a term that began in January of 2011 and will end this December. During each two-year term, any legislation introduced during the first year remains active for the second year. That’s good news for stroke-related legislation that wasn’t acted on by Congress in 2011. It means those bills don’t have to start the legislative process over again—they just pick up where they left off at the end of last year.

In June, National Stroke Association hosted advocates from all over the country in Washington, D.C. They met with their members of Congress to voice support for stroke-related legislation. Two of the issues they advocated for are summarized in other articles in this e-newsletter—funding for the National Institutes of Health (NIH) and Medicare therapy caps. However, our advocates also asked for support for two other bills in June—the Part D Off-Label Prescription Parity Act and the Heart Disease Education, Analysis, Research and Treatment for Women Act, also known as the HEART for Women Act.

Because Congress is in the middle of its term, these bills could still be acted on in 2012. Here’s an update on how they ended 2011.

Part D Off-Label Prescription Parity Act (H.R. 1055)

This bill would allow Medicare (Part D) to cover off-label uses for prescription drugs if those uses are supported by clinical evidence and meet certain federal guidelines. Since the bill was introduced by Representative Mac Thornberry (R-TX), seven other Representatives have signed on as co-sponsors. Co-sponsoring a bill is a way for a member of Congress to show their support for it before it comes up for a vote. One of those co-sponsors is Representative Michael Michaud (D-ME), whose staff met with one of our advocates in June. Unfortunately, no additional action has been taken on the bill. However, a member of Representative Thornberry’s staff says that the Congressman is continuing to push the bill through the process and is actively seeking out a Senator to introduce a companion bill in the Senate.

HEART for Women Act (S. 438 and H.R. 3526)

This bill requires the federal government to:

• Ensure that women and racial minorities are adequately represented in medical studies,
• Study the quality of care received by women who suffer from stroke and other conditions,
• Study women’s access to treatment for stroke and other conditions, and
• Expand funding for a program that provides support to certain low-income women to prevent, delay and control stroke and other conditions.