Pending legislation would end therapy caps

Cynthia Morton

A measure to terminate Medicare therapy caps will soon be introduced in Congress, a top association official said during a McKnight's Super Tuesday webcast yesterday.

But Cynthia Morton, executive vice president for the National Association for the Support of Long Term Care (NASL), acknowledged lawmakers already understand the issue, and cautioned the bill faces long odds.

“We hear a lot of, ‘Yes, okay, I get it,” she said of members of Congress. “We may be headed toward ‘therapy cap fatigue.'”

President Obama signed the Medicare and Medicaid Extenders Act last year. This new law directs the Centers for Medicare & Medicaid Services to continue exceptions to therapy caps for certain medically necessary services provided through 2011. Most skilled nursing residents are covered by the exceptions process. For physical therapy and speech language pathology services combined, the limit was $1,860 in 2010 and $1,870 in 2011. Those are also the limits for occupational therapy services.

Morton also discussed the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) competitive bidding program. She also addressed accountable care organizations, which will be incentivized to provide high-quality care and keep patients out of emergency rooms. Skilled nursing facilities need to weigh their options when it comes to participation in these organizations, she noted.

“There may be no size difference for nursing homes in terms of getting ready for ACOs,” she said. One issue, however, is whether rural areas or smaller groups would attract the needed number of beneficiaries. Current guidelines would require 5,000 beneficiaries, and Morton said providers might actually have to cover more people if they hope to be financially viable.

The next McKnight's Super Tuesday webcast will address reimbursement issues. That event will be held on May 3.