As many as 80% of the 800,000 patients who will exceed the therapy cap this year will qualify for the auto-exception process, according to an official from the Centers for Medicare & Medicaid Services.
Medicare part B beneficiaries who are expected to exceed either of the two $1,740 limits could qualify in two ways, said Kim Brandt, Director of Program Integrity at CMS. They can have either an automatic exception based on “face value” criteria or use a paperwork process whereby the agency must respond in 10 days or the treatment will automatically be authorized. Brandt spoke during the Winter Conference of the National Association for the Support of Long Term Care.
Brandt also outlined the timetable and process for this year’s therapy cap exception rule. She cited April 1 as the date the exception process should be operational. CMS is preparing to release documents intended to specify general clinical criteria for the two types of exceptions.
