Resident care would suffer if Congress acts on the latest recommendations from the Medicare Payment Advisory Commission, long-term care advocates say.
Lowering yearly therapy caps is a “dire, scary recommendation,” Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care, told McKnight’s.
Medicare contractors would have to manually review cases to approve or deny payment for therapy in excess of the caps. With the combined therapy cap at $3,700, manual reviews were so delayed that CMS had to revamp the system, Morton said. If the caps are reduced to $1,270 each, the number of reviews could triple, and patients would pay for a bureaucratic logjam, she said.
MedPAC sought to address this concern, proposing a 10-day manual review, which would allow providers to submit requests electronically for the first time.
Morton said this is a “good start,” and MedPAC has tried to address provider input. However, “electronic” is vague language, and reviewers are not likely to accept PDFs containing personal health information, she cautioned.
American Health Care Association President Mark Parkinson called for better data to “measure the value” of therapy, which could form the basis of smarter reforms.
From the July 01, 2013 Issue of McKnight's Long-Term Care News
