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Independent Practitioners under Medicare (1998)

RECOMMENDATIONS

Physical Therapy

IT IS RECOMMENDED that present coverage for services of physical therapists remain as established in the 1967 Social Security Amendments, which extended coverage to outpatient services provided by approved providers, including rehabilitation agencies, clinics, and public health agencies meeting conditions of participation.

Occupational Therapy, Clinical Psychology,
Social Work, Speech Pathology

IT IS RECOMMENDED that coverage he expanded for services Of Occupational therapists, clinical psychologists, social workers, and speech pathologists provided by organized agencies. centers, or other programs that are not presently eligible for participation and that meet requirements established by the Secretary and designed to promote maximum coordination, continuity, and quality of care, and to which patients are referred by a physician, who establishes a plan for the patient's total care and who retains over-all responsibility for patient management. Reimbursement for services would be to the provider agency, center, or program on the basis of reasonable cost.

Optometry

IT IS RECOMMENDED that present coverage for optometric services not be expanded at this time.

Audiology

IT IS RECOMMENDED that no changes be made in present coverage for services of audiologists.

Corrective Therapy

IT IS RECOMMENDED that no changes be made in present coverage for services of corrective therapists.

Chiropractic

IT IS RECOMMENDED that no changes be made in coverage in relation to the services of chiropractors.

Naturopathy

IT IS RECOMMENDED that no changes be made in coverage in relation to the services of naturopaths.

Priorities Among Services Studied

The services of practitioners considered in this study represent only one set of a number of gaps in the Medicare program. Establishing priorities among these services. therefore, does not imply that there may not be even more important needs for the elderly which must someday be met through the program. For example, the exclusion of routine physical examinations and the $50 deductible under Part B, together. prevent many elderly persons from entering the health care system for early treatment of medical conditions, or for health maintenance or preventive services. For many of the elderly, the deductible operates all too well as a deterrent to seeking care, and frequently the decision to make this expenditure from limited funds is reached only after the disease condition is well advanced and disabling. Other significant gaps in Medicare coverage with respect to the needs of the elderly are immunizations, drugs, and dental care services.

Considering only the services in this study. determination of priorities was based on potential of the services to contribute to maximum restoration of function among geriatric patients, and early return. to the extent possible, to normal activities of daily living. It was determined that the professions with the greatest potential for meeting the restorative needs of beneficiaries were clinical psychology, occupational therapy, physical therapy, social work, and speech pathology. No distinction in priority was made among these services, since any one could be of highest priority to the patient who needs it. However, the 1967 amendments to the Social Security Act expanded coverage for outpatient physical therapy service to include services in essentially all organized settings that could meet Medicare standards for participation.

IT IS RECOMMENDED, therefore, that highest priority be given to providing similar coverage for services of clinical psychologists, occupational therapists, social workers, and speech pathologists, without attempting to set priorities within this group.

Estimated Costs

Estimated costs of the recommended extension of coverage for services of clinical psychologists, occupational therapists, social workers, and speech pathologists are shown in the table below. These estimates are based on services provided, on referral from a physician, in organized settings comparable to the providers identified for present coverage for outpatient physical therapy services.

Cost in 1969

Increase in Premium/Month (Total)
Psychologists

 $2,000,000

1.0¢

Social Workers

$10,000,000

4.5¢

Speech Pathologists and Audiologists (not including hearing examinations for prescribing, fitting, or changing hearing aids)

  $2,000.000

 1.0¢

Occupational Therapists

  $1,000,000

0.5¢

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