Therapy caps back on as Congress delays action

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NASL's Cynthia Morton says the clock is ticking on therapy limits.
NASL's Cynthia Morton says the clock is ticking on therapy limits.

Therapy caps are back on for now, even though Congress may still be prepared to eliminate them in 2018.

An exception to the cap limit allowed Medicare Part B patients — many suffering from stroke or other debilitating conditions — to receive medically necessary treatment above the standard caps set by the Centers for Medicare & Medicaid Services. But that exception expired Dec. 31, meaning the cap is back in effect for all rehab settings including nursing homes.  

In mid-December, a coalition of 26 groups representing seniors and health professionals asked Congress to extend the hold on caps for physical and occupational therapy and speech language pathology services. But lawmakers, focused on passing a tax reform bill and a bill to keep the government open, did not make it to debating the caps.

Now observers are watching the calendar carefully.

The Senate went back to work Wednesday and the House will not be back in session until next week, giving legislators little time to craft budget bills, let alone tax therapy limits.

A real answer on therapy caps may still be weeks away, experts said.

“From a patient perspective, the longer the therapy cap with no exceptions process is in effect, it becomes a problem,” Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care, told McKnight's. “As we get into late January and into February, patients will begin to hit the CY 2018 Therapy cap of $2,010 for occupational therapy and a separate $2,010 cap for physical therapy and speech language pathology combined. From a provider perspective, providers have to communicate this to patients and help them understand the state of their benefits.”

Congress could act on existing Medicare Extender legislation, a bipartisan agreement that includes a full repeal of Medicare Part B therapy caps, as part of either a second stop gap or its final spending 2018 budget.

Morton said she has not seen any communication on therapy billing from CMS, but noted that providers have been told in previous, similar situations to “hold claims for a period of time believing that Congress will act.”

Meanwhile, CMS late last month issued an update on “Always Therapy” codes used to track therapy cap limits. The coding changes went into effect Jan. 1.