Module 4 Interaction Project

1 Running head: MEDICARE OUTPATIENT THERAPY SERVICES

Medicare Outpatient Therapy Services

Jane Doe

Colorado Community College

April 15, 2018

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Medicare Outpatient Therapy Services

In the United States, we are fortunate enough to have a democratic government that

encourages people to participate. Political participation can be done in many ways including

voting, protesting, petitioning, giving to political causes, attending meetings, and contacting

representatives (Edwards, Wattenberg, & Lineberry, 2014, p.215). Many citizens choose not to

participate in our government, or only participate by voting, which is the most common form of

political participation. For this assignment, we were encouraged to participate in our government

by writing a representative, serving as a representative, or attending a government meeting.

I decided to contact Montana’s House Representative and two Senators. I sent them each

a separate letter on their government websites regarding my confusion on the cap that was placed

on Medicare Outpatient Therapy Services. These letters were sent to Representative Greg

Gianforte, Senator Jon Tester, and Senator Steve Daines. I initially sent letters to each entity on

January 30, 2018, to which I did not receive a response from any of them. After I submitted my

outline for this interaction project, I decided that maybe my emails did not go through, so I went

through and sent each of the representatives another letter, requesting more information on the

cap on March 26, 2018. I received responses in a timely manner to my second letters.

Medicare outpatient therapy services include occupational therapy, speech pathology, and

physical therapy. There was to be a cap placed on these services by January 1, 2018, at which

Medicare recipients could not receive occupational therapy after their $2,010 cap was met, or a

combined cap of $2,010 was met for speech pathology services and physical therapy (Parsons

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2017). Since January, I have found this subject to be quite confusing, and I was never positive on

what was going on with it.

Since I started this project at the beginning of the semester, there have been changes and

actions taken to repeal the cap on Medicare outpatient therapy services. According to the

American Speech-Language-Hearing Association, “Congress has repealed the hard cap and

established a targeted medical review threshold of $3,000. Once patients have exceeded the

previous therapy cap amount of $2,010, speech-language pathologists are required to apply the

KX modifier on the claim form to attest to ongoing medical necessity and continue to submit

claims for coverage. If the speech-language pathologist meets the targeting criteria established

under the law, then the medical records for some of their claims above the $3,000 threshold may

be requested for review” (February 8, 2018). Because Congress acted, Medicare recipients will

be able to receive these services beyond the previous cap. “Confusion ensued in early 2018,

when therapists and patients were unsure how much therapy would be covered for Medicare

beneficiaries in 2018. But in February 2018, Congress passed legislation that repealed the

outpatient therapy caps, retroactive to January 1, 2018” (Norris, 2018). Actions were also taken

to provide speech-generating devices under Medicare for those that need them. Speech-

generating devices are used by those who cannot verbally communicate their needs or have

speech impairments. The largest population of those who need these devices are patients with

amyotrophic lateral sclerosis, multiple sclerosis, and Parkinson’s disease (American Speech-

Language-Hearing Association, February 8, 2018).

I chose to interact with Representative Gianforte, and Senators Testor and Daines

because I thought they would be the quickest way in which I could receive clarification on

Medicare outpatient services. There has been a lot of confusion regarding this topic since last

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year, and I was hoping to get my questions answered straight from the source, instead of relying

on what I am able to find on the internet. Therapy services have become relatively important to

me this past year, as many people I know use one of these services, although not under Medicare.

Personally, my three-year-old son has recently began receiving speech pathology services

through the school system, to which we are very thankful. My boss has also recently had a

stroke, which has required him to receive both speech pathology services and physical therapy. I

have been able to see the amazing impact these services can have and hope that anyone who

needs a therapy service, is able to receive it to the extent they need.

This experience did not turn out to be quite what I expected when I initially started the

project. Before I sent letters to each of the representatives, I thought that it would be more

difficult to get into contact with them than it was. This was a pleasant surprise. I was able to find

their contact information easily on their government websites. From there, the option was given

to send them an email, and it even gave some options of topics to contact them about. I honestly

did not expect it to be that easy to interact with the government on that level. I received my first

response from House Representative Greg Gianforte the day after I sent my letter. This was a

pleasant surprise to me as well, because I assumed that I would be waiting at least a few days to

receive a response. I also received responses from Seator Jon Tester and Senator Steve Daines

within a week of contacting them.

Like many other Americans, my biggest form of interaction with the government was

voting before this assignment. Although I find voting to be the most important way we can

interact with our government, by contacting government officials, I felt more involved. Instead

of only interacting on their terms, I took the initiative to contact them regarding a subject that I

didn’t understand fully. Voting can also seem impersonal or meaningless at times. By contacting

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them on my terms, I felt that my answers came back personally, and that what I was inquiring

about was important and mattered. Another interaction that I have had with the government was

attending a city council meeting. I didn’t necessarily react at the meeting and was merely there to

listen. The meeting that I attended was rather short and followed a quick schedule. This is why I

chose not to attend a meeting for my interaction project. I felt that I didn’t get enough

information, and I didn’t fully participate myself. When I sent letters to government

representatives, I felt that I was fully participating, and I couldn’t just sit back and listen without

initiating some conversation.

This experience has been mainly positive for me. It has encouraged me to interact with

the government in the future. When I interacted, I felt much more involved than I ever have

before. The experience made me feel that if I don’t understand something in the future, I am able

to contact the government on my own to get the answers to my questions. I used to feel that if I

didn’t understand something, I just had to do the research on my own. Now, I will be more likely

to take initiative to find out the correct answers right from the source. The biggest lesson that I

learned from this project is that if we don’t understand a government policy, we shouldn’t feel

ashamed to ask the questions we have. Next time I interact with the government by sending

letters, I would make sure to ask more specific questions about the subject that I was contacting

them about. I felt that I might have been a little vague in my questions, so in return, I didn’t feel

like the responses I got fully answered my questions. As I mentioned before, I received my first

response from Greg Gianforte the next day. However, his response was not quite what I

expected, and I didn’t get the answers that I was searching for. I felt that I was answered quickly

without really looking at the questions that I was asking. It was great that he got back to me so

quickly, but my confusion was not settled by his response. The next response I received was

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from Senator Jon Tester on March 29th. His response was quite short and to the point. The only

thing he mentioned about the cap on Medicare outpatient therapy services, was that it was

repealed. I was glad to hear an answer as to what was currently going on with the cap, but he

didn’t go into depth at all, so I felt that I didn’t get exactly what I wanted to know fully across to

him. Senator Steve Daines was the last to respond to my email on April 3rd. He also did not

answer my questions to the extent I expected, but he did mention what was happening with

speech-generating devices, which I appreciated. Next time I interact with the government this

way, I will be more specific, ask more questions, and follow up if I don’t get responses that

answer my questions.

This project ties into our course, by providing us with the opportunity to participate in our

government in a way which we might not before. According to our textbook, “voting is the only

aspect of political participation that a majority of the population reported engaging in” (Edwards,

Wattenberg, & Lineberry, 2014, p.216). In February, we all participated in a class discussion

about political participation. In this discussion, we talked about the low voter turnout. Many of

us mentioned that a large number of American citizens don’t feel like they really matter when it

comes to politics. This project showed me that my thoughts and questions do matter and will be

answered if I take the initiative to participate.

From this experience, I have learned that it is truly simple to interact with a democratic

government. We have so many opportunities to be involved, that most of us take for granted. We

are able to vote, contact many different levels of government, attend meetings, sign petitions,

protest, and give to political organizations. Our democratic government provides us with ways to

participate, and it is up to us to take advantage of the opportunities that are presented in front of

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us. I also learned through this project, that representatives are willing to answer our questions,

which is something I didn’t necessarily think before.

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References

American Speech-Language-Hearing Association. (February 8, 2018). Congress permanently

repeals the medicare therapy caps and ensures payment for speech-generating devices.

American Speech-Language-Hearing Association.

https://www.asha.org/News/2018/Congress-Permanently-Repeals-the-Medicare-Therapy-

Caps-and-Ensures-Payment-for-Speech-Generating-Devices/.

Edwards III, G.C., Wattenberg, M.P., & Lineberry, R.L. (2014). Government in America:

People, politics, and policy (16th ed.). Boston, MA: Pearson.

Norris, L. (2018). How did medicare benefits change for 2018? Medicare Resources.

https://www.medicareresources.org/faqs/what-kind-of-medicare-benefit-changes-can-i-

expect-this-year/.

Parsons, H. (2017). Access to therapy services threatened if congress fails to act. The American

Occupational Therapy Association, Inc. https://www.aota.org/Advocacy-

Policy/Congressional-Affairs/Legislative-Issues-Update/2017/Access-to-Therapy-

Services-Threatened-if-Congress-Fails-to-Act.aspx.