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  March 28, 2005 RMI Part B CAP Repeal Toolkit by Mark Knepper Rehab Management, Inc. has taken a proactive approach in dealing with this very important legislative issue that will greatly impact our residents and seniors. We have provided for you a very comprehensive toolkit to help address the Part B cap. Letters and case studies are also provided for your benefit. Please feel free to use all the provided information however you wish. Every one of us who provides care to seniors needs to work on repeal, they deserve it! Good luck!
The CAP is again rearing its ugly head in 2006—and it does not appear that it will be repealed. We need to take a front-seat in this process and aggressively offer alternative approaches to the CAP. Such approaches could be either clinically or comorbidity based. The CAP is not fair for a patient in a nursing home that has comorbidities and a golfer who goes to an outpatient clinic under Part B for a muscle problem. It is not fair to allow the same amount of dollars across the board; the fund access for a patient with several diseases in a Skilled Nursing Faclity is limited. It is also not fair to limit access to funds based on geography, as Part B funding is partly based on rural and urban formulas. Why should a patient have less access because of his or her location? Note that the GAO is studying ‘02 data and that this is not a proper sampling of Part B usage; CAP’s were in place during ‘02. We are in the same situation we were in before—the position of having to quantify what we do clinically. Congress has no intention of doing anything until the GAO (Government Accountability Office) gives its report—and the GAO is a little gun shy with realizing data because they have prematurely released data before. In the mean time, we as an industry must be a strong, unwavering voice throughout this entire process. AHCA/NASL can respond to any outcome the GAO reports based on its findings. The first step we should take is “Total Repeal”! We should lobby for another 1-2 years of moratorium to figure this out using proper data. We need the time as an industry. Senator Grassley has stated: “He needs a fix for these nursing homes patients—he feels we need another year on the moratorium.” Once the GAO releases their data—we, as a group, must be able to respond quickly. We need to work on our own in representing Skilled Nursing Faclities because our Part B business is so much different than Outpatient clinics. With the moratorium in place, many have lost touch with the CAP’s. But the issue still looms large over our industry. We cannot take a “Wait and See” attitude—we must be proactive! The time is now for restarting our phone, email, and letter writing campaigns. Below are some web addresses that can help you in this process.
Other Relevant Sites:
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