Without Congressional action, Medicare beneficiaries will face a cap of $2,010 for PT and speech therapy services as of January 1, 2018.
Earlier this year, a bi-partisan group of legislators introduced the “Medicare Access to Rehabilitation Services Act” (H.R. 807/S.253), a bill that would permanently repeal the Medicare Outpatient Therapy Cap. Supporters had hoped the repeal would be settled by now, instead they worry it may get lost among other federal legislative priorities including tax reform.
The American Occupational Therapy Association (AOTA) weighed in on the legislation to lift the cap earlier this year,
AOTA urges Congress to revisit this important issue before it expires at the end of 2017. This 20 year-old policy is outdated. Payment for outpatient therapy services needs to be aligned with recent policies enacted by Congress that focus on providing high-quality, coordinated care.
However, repealing the therapy cap requires lawmakers to figure out how to pay for the estimated $6 to $7 billion in additional costs needed to offset the additional spending – all at a time when year-end negotiations are at their hottest.
In April 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which narrowed the therapy claim review process from all claims to a “targeted review process.” MACRA also replaced the use of Recovery Auditors to Strategic Health Solutions to perform the medical review process on therapy claims.
Currently, Medicare beneficiaries are capped at $1,980 for physical and speech therapy each calendar year, which equates to about 1,000 minutes of therapy annually. Beneficiaries are also eligible for $1,980 for occupational therapy (OT) services.
Patients may apply for an exception if it’s medically necessary to go beyond the limits, but there are additional limits (thresholds) which if exceeded may trigger additional review.
- $3,700 for PT & SL
- $3,700 for OT
Read more in Skilled Nursing News
Read a recent news brief on therapy caps from the National Association for the Support of Long Term Care
Check out an upcoming free webinar from i Advance Senior Care on December 19, 2017.
Learning objectives for this one-hour webinar include:
- Summarize 2018 CMS Policy mandates and prospective legislation related to skilled nursing and assisted living operations
- Describe the repeal the longstanding Part B Outpatient Therapy cap and the replacement medical review of claims program, including criteria for medical review and a continuing requirement for providers to use the KX modifier on the claim
- Breakdown quality measures mandated by the IMPACT Act and when data collection could begin
- Learn important issues in the near term including Part A reimbursement changes the Centers for Medicare and Medicaid Services (CMS) could propose
- Model the new Resident Classification System-1 (RCS-1) model, and how this could impact reimbursement into 2018