Therapy cap exception may soon ease regulation's blow

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Some nursing home residents already may have felt the blow of the newly enacted Medicare Part B therapy caps. But a new exceptions policy, if approved, could take some sting out of the initiative.
The House this month is expected to vote on the Deficit Reduction Act of 2005. It contains provisions that allow for a new exceptions policy to the cap. The policy could take effect as early as mid-March, according to the American Health Care Association.
The exceptions policy, as it was proposed in the bill, allows patients to apply for additional therapy services if their treatment is deemed medically necessary and expected to exceed the cap. The Centers for Medicare & Medicaid Services (CMS) will determine that process by expedited rulemaking, according to officials. As part of the proposed policy, if a request for services above the cap is not denied within a 10-day period, then the exception would be approved.
As the caps law currently stands, Medicare Part B therapy recipients may receive only $1,740 worth of physical and speech therapy and $1,740 worth of occupational therapy at a skilled nursing facility. After they exceed the cap, they must continue treatment at other healthcare facilities that are not subject to the cap. (Some residents, however, don't have this option.) The most recent moratorium on the caps expired Jan. 1.
Prior to the caps being brought back to life last month, nursing home advocates partnered with lawmakers to urge CMS to delay implementation of the caps.
AHCA said it also has been working to ensure that an exceptions system is simple and easy to use.