'Extenders' package would repeal therapy caps, but SNF payment changes may be included

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Cynthia Morton
Cynthia Morton

Skilled nursing providers found both good news and bad news Thursday in a House bipartisan agreement statement on a Medicare extender package.

House Ways and Means Committee Chairman Kevin Brady (R-TX) and Ranking Member Richard Neal (D-MA) announced a bipartisan agreement Wednesday that included a repeal of Medicare Part B therapy caps.

The repeal would hit Jan. 1. Part of it would include lowering the threshold for targeted manual medical reviews for claims to $3,000 for physical therapy/speech language services and $3,000 for occupational therapy. The current threshold is $3,700. Providers would continue the process of needing to attach a KX modifier to the claim when therapy services hit exceptions, but “it doesn't stop care,” explained National Association for the Support of Long Term Care Executive Vice President Cynthia Morton.

She called the repeal “pretty exciting,” telling McKnight's that even while big-ticket items for Congress are stacking up, she believes there's momentum to end the 20-year-old therapy cap problem.

Lawmakers “really want to show the country they can come together in a bipartisan package,” she said. “There's a desire to fix it once and for all.”

LeadingAge officials also said they were pleased by the therapy cap bullet point, as well as with signs of a five-year straight extension of the Home Health rural add-on, reauthorization of special needs plans and two-year extension of the State Health Insurance Assistance Programs. LeadingAge leaders, however, said they wanted to reserve further judgment until it saw the legislation.

Of concern to all is the mention that extender offsets could include payment reductions for certain end stage renal dialysis services, modifications to home health agencies and modifications to skilled nursing facility payment. The last had many scratching their heads as to what the legislation might end up doing to skilled nursing facilities.

“We are deeply concerned about the impact on the long-term services and supports system of across-the-board cuts and other potential changes to the payment system,” LeadingAge said.

The language could mean anything as dire as not giving the skilled nursing sector a payment update/increase, Morton warned. That means that even with the positive news around therapy caps, providers could take a hit to their bottom lines.

“The therapy cap language doesn't bring new dollars into a building,” Morton said. “We don't know what these SNF offsets are.”