Rogena Schuyler Silverman

“The future of health care security should include flexibility from the federal government to allow us to serve the state’s most vulnerable citizens.”


On July 15, Congress voted to override President George W. Bush’s veto of HR 6331—The Medicare Improvements for Patients and Providers Act of 2008. With this action, the bill became law, delaying the implementation of Medicare’s competitive bidding program by 18 to 24 months. In addition, HR 6331 exempts high-end or complex rehab items from the bid program. A 9.5% reimbursement cut on all items included in the first round of competitive bidding (including complex rehab) will serve as payment for the delay.

Ironically, competitive bidding was briefly in effect from July 1 though 16, implementing a 26% cut in scheduled reimbursements. With the passage of HR 6331, old reimbursement schedules have been reinstated, at least through December 31, 2008. As of January 1, 2009, reimbursements for certain durable medical equipment groups, like complex/power rehabilitation equipment, will revert to the 9.5% cut.

Although lobbyists and advocacy groups representing physical medicine and rehabilitation professionals, medical associations, patient groups, manufacturers, disability organizations, etc, are claiming victory after tireless efforts to inform and educate Capitol Hill decision-makers as to why competitive bidding in its current context should not be implemented, there is still plenty of confusion across the board as to what this all means for professionals working within the physical medicine and rehabilitation industry. For example, since CMS confirmed the implementation of competitive bidding for durable medical goods last year, manufacturers have been cutting back on production, as well as research and development (since their customers may have gone out of business due to competitive bidding). However, with the delay, Medicare billings are back to normal.

Also, the delay of competitive bidding, and the passage of HR 6331, will enable occupational therapists and physical therapists to recommend preferred products for their clientele, as well as work with their preferred providers. In addition, it provides an 18-month extension of therapy cap exemptions, to ensure seniors and persons with disabilities access to occupational, physical, and speech-language therapy.

As competitive bidding moves into its new incarnation, it is paramount that lobbyists, advocacy groups, and special interest organizations continue to emphasize the importance of providing specialized care for long-term patients and seniors. Rehab Management will continue to provide a platform and information source along that journey.

—Rogena Schuyler Silverman