CMS warns: Medicare therapy caps back in full effect soon

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A process that shields most nursing home residents from therapy payment caps is set to expire at the end of next month, federal regulators told providers Thursday during a special conference call. Officials with the Centers for Medicare & Medicaid Services also announced that new surveyor guidances covering nutrition and food handling would be issued in July or August.

Barring the passage of special legislation before July 1, a wide-ranging therapy cap exceptions process would expire, listeners heard during Thursday afternoon's SNF Open Door Forum. That would leave residents open to the full brunt of annual limits of $1,790 for occupational therapy and $1,790 for speech and physical therapy combined. In addition, therapy performed during the first half of 2008 would count toward the limits, said CMS' Sheila Lambowitz.

"It's kind of dicey right now," said Peter Clendenin, executive vice president of the National Association for the Support of Long-Term Care, in a phone interview after the conference call. "I'm hopeful, but I've stopped giving out odds. It really comes down to the Senate and whether they'll be able to get Medicare legislation passed."

The hope is to achieve an 18-month extension of the exceptions process, which covers 85% to 90% of nursing home therapy claims, Clendenin said. Ultimately, he said, the goal is to change the entire method of paying therapy claims.

Also during the CMS conference call, regulators said an updated pain guidance (pertaining to F-tag 309) should be out by the end of the year.

Lambowitz also announced somewhat cryptically that CMS plans to introduce a "new initiative" as part of the next Open Door Forum call on June 24. Advance information could be coming on it about two weeks beforehand she said, without elaborating.