GAO recommends improvement to therapy caps system

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Providers are praising a finding from a recent Government Accountability Office that calls for a clinically based payment system for Medicare therapy services to ensure that elderly beneficiaries have access to the rehabilitative care they require.

The finding is is an argument against the Medicare therapy caps that limit the amount of therapy beneficiaries can receive to about $1,750 per year of physical, occupational and speech therapy. The caps are scheduled to take effect again Jan. 1, when a moratorium is set to expire. The Senate budget bill is calling for a one-year extension on the moratorium now in effect.
"The cap on Part B Medicare therapy services was intended as a cost control mechanism, but instead has punished the most acute Medicare patients – primarily those residing in skilled nursing facilities," said Bruce Yarwood, acting president and CEO of American Health Care Association.
The Department of Health and Human Services is exploring the possibility of creating such a system, the study said. In a statement, the AHCA said it supports a condition-based payment system for therapy services that would provide an aggregate condition limitation that is risk- adjusted for setting and other clinically appropriate variables.
The full GAO report, "Little Progress Made in Targeting Outpatient Therapy Payments to Beneficiaries' Needs" can be viewed at