This tax bill signed into law on December 22nd had pieces of healthcare policy tucked inside. The law repeals the individual mandate as of 2019. According to the Congressional Budget Office (CBO), without the individual mandate, healthy people may opt out of getting insurance, and the number of uninsured Americans would increase by 13 million by 2027, additionally premiums could rise 10 percent more per year than they would without this change. That is because healthier people would be most likely to drop insurance in the absence of a fine, so insurers would have to raise premiums to compensate for a sicker group of customers who would be left with fewer affordable choices. The law will allow people to deduct medical expenses above 7.5% of their income for 2017 and 2018. In 2019 the threshold will back up to 10%.
The law will grant some pass-through service business a tax break. "Service" business owners who pay business taxes through their individual tax returns will be able to access a 20% deduction—but only if their taxable income is less than $157,000 individually (or $315,000 if filing jointly). This is a brand-new provision in the reform bill that may apply to PTs in private practice. You should contact your tax professional for advice.
The bipartisan Medicare Access to Rehabilitation Services Act (H.R.807/S.253) continues to gain cosponsors. The House added 8 more cosponsors to reach 229 cosponsors. The Senate bill has exceed its historical high by 2 and now has 36 cosponsors. H.R.807/S.253 is a message bill which would permanently repeal the $1,980/year arbitrary therapy cap imposed on Medicare beneficiaries for 2017. The cap on therapy will increase to $2010 in 2018.
On December 13th, the House released their language for legislation to fund the government also known as the Continuing Resolution (CR). It been widely expected that the Medicare Extenders (which includes the language to permanently repeal the therapy cap that PPS, along with other stakeholders, agreed upon with the staff of the three committees of healthcare jurisdiction) would be part of this package, however the Medicare Extenders weren’t included in the legislation. The current exceptions mechanism expires on December 31, 2017; legislators left Washington without addressing this important issue. We will be working hard in early 2018 to continue our pursuit of a permanent therapy cap.
Advocacy Opportunity: Make sure your legislators understand how impactful it will be to permanently repeal the therapy cap. As was suggested in the recent Action Alert, reach out to your Representative and both Senators and follow up with an email to the Health LA where you reiterate how important it is to you and your patients that the therapy cap be repealed, and attach this letter which PPS and the Therapy Cap Coalition sent to Congressional leadership asking for swift action to repeal the therapy cap. Please share examples of patients who have surpassed the $1980 threshold and explain why the patient required so much care as well as share your experience with the exemptions process. Please cc your lobbyist, Alpha Lillstrom Cheng (firstname.lastname@example.org) on the email to your legislators.
Health and Human Services
On November 13th, President Trump nominated Alex Azar to be Secretary of Health and Human Services (HHS). His Senate confirmation hearing in front of the HELP Committee was on November 29th; the Finance Committee has yet to schedule their confirmation hearing. Azar formerly served as HHS Deputy Secretary and General Counsel under President George W. Bush and has deep Indiana connections having worked closely with both Vice President Pence and CMS Administrator Seema Verma.
Comprehensive Care for Joint Replacement (CJR)
On December 1st CMS published a final rule in which the expansion of CJR to SHFFT was officially cancelled. Furthermore, the program has been scaled back and now requires participation from hospitals in only 34 of the original 67 geographic areas that were selected for the CJR model that began in 2016. IPPS hospitals in the other 33 of the original 67 areas will be allowed to continue participating on a voluntary basis, but are required to send a participation election letter to CMS by January 31, 2018 in order to remain a part of the model. Once a hospital elects to voluntarily participate, they are locked in for the duration. The fifth and final performance year will end on December 31, 2020. Additional flexibility for episode costs is granted to those hospitals which are located in regions which experience severe weather events like the hurricanes and wildfires this summer and are designated as major disaster areas and granted authorized waivers by the Secretary of Health and Human Services (HHS).
For one-pagers and talking points for other PPS’s legislative priorities and activities,
visit the Grassroots Advocacy section of the PPS website at www.ppsapta.org
Thank you for a great year of engagement and advocacy!