While Congress Delays, Medicare Moves Forward on Therapy Caps

Physical, speech, and occupational therapists were discouraged last week when CMS posted a statement saying that it would begin the process to implement the statutorily required therapy cap – a requirement from the 1997 Balanced Budget Act that Congress has since prevented from being implemented through a series of short-term delays.

The most recent Congressional exception to the Medicare therapy cap expired on December 31, 2017. If implemented, the cap in 2018 would apply when expenses for Medicare patients in physician, speech, and occupational therapy reach $2,010. 

The therapy cap exception is one of several “Medicare extenders” that have often been extended for one and two years; these extenders are under consideration to be included in the larger federal spending bill for the remainder of FY2018, which must be addressed by February 8 (see story below). Prospects for a permanent repeal of therapy caps looked promising late last year when the House included a permanent repeal in the Medicare extenders package that the House Ways and Means Committee approved. But as other issues dominated Congressional attention, the extender package along with therapy caps failed to garner the urgency needed for action. 

The CMS notice did provide some breathing room by stating that starting January 31, CMS will begin to release therapy claims under a “rolling hold” for 20 days to help minimize the number of claims requiring reprocessing if the extenders package, including the therapy caps exception, is passed.  The CMS action brings attention to all the expired Medicare policies included in the extenders package, including payments for Medicare dependent hospitals, low-volume adjustment hospitals, rural ground ambulance add-on, rural home health add-on, among others.