Medicare doc payment bill doesn't 'fix' therapy caps

The historic repeal of the “doc fix” this week left about equal numbers of stakeholders relieved and disappointed. Among the most crestfallen: Therapy providers who were hoping for Congress to finally repeal Medicare Part B outpatient therapy caps.

The legislation failed to repeal an annual per-beneficiary cap for outpatient therapy services that's been in effect since 2006. The ceiling is in place except when therapy is received from a hospital outpatient department.

Passage of the Medicare Access and CHIP Reauthorization Act of 2015 (also known as HR 2), which the president signed Thursday afternoon, provides expansive payment relief for physicians but leaves therapy patients out in the cold, critics say. An amendment that would have removed the caps fell short by two votes in the Senate. The bill extends the current exceptions process through 2017.

That led amendment sponsor Sen. Benjamin L. Cardin (D-MD) to declare that “arbitrarily capping vital rehabilitation services would likely cause Medicare beneficiaries to delay necessary care, assume higher out-of-pocket costs, and disrupt the continuum of care for many seniors and individuals with disabilities.”

AARP Chief Executive Jo Ann Jenkins added in a public statement: “Many Medicare patients, particularly stroke victims and people with Parkinson's and multiple sclerosis would have benefited.” Jenkins vowed to continue working “to remove this arbitrary coverage cap.”

Another disappointment in HR 2 was a shorter funding extension for special needs plans in Medicare Advantage. The program benefits Medicare/Medicaid dual-eligible beneficiaries.

The bill also requires Health and Human Services to explore alternative payment models in the Medicare Advantage program, including the use of a value-based modifier, and requires the Government Accountability Office to compare quality measures used for fee-for-service Medicare with Medicare Advantage, Medicaid and private payers.