AHCA gears up for annual therapy caps fight, pushes to reform therapy rule

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Dave Hebert
Dave Hebert

As the end of the year approaches, long-term care providers will be lobbying to extend the therapy caps exceptions process, which is set to end Dec. 31. Another therapy issue—a proposed rule to reduce payments when multiple therapy procedures are provided to a Medicare beneficiary in one day—also is on providers' radar screens. 

The American Health Care Association is concerned about the financial impact of the Multiple Procedure Payment Reduction (MPPR) rule, according to David Hebert, senior vice president of policy and government relations at AHCA. The rule, which the Centers for Medicare & Medicaid Services proposed in June, would reduce the Medicare practice expense for the second and subsequent therapy services by 50%. It could result in a major hit to Medicare Part B therapy payments if it goes into effect, said Hebert, speaking during an educational session at AHCA's annual conference this week. When combined with other therapy reductions, the cumulative effect could be significant, he said. 

Meanwhile, it's “Groundhog Day for therapy caps,” Hebert noted at the conference in Long Beach, CA, which ends today. A current exceptions process, which expires at the end of the year, allows residents to receive exceptions from $1,860 annual caps for physical and speech therapy, and another $1,860 cap for occupational therapy. Congress has been continually extending the exceptions process for Medicare Part B therapy to stop the enactment of the caps. 

Also expiring on Dec. 1 is the so-called “doc fix,” which halts cuts in reimbursements for physicians. Doctors are calling for a 13-month fix. The healthcare reform law extended both the doc fix and therapy caps exceptions process until December.

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