Therapy Cap

Last year, both H.R. 1125, introduced by Representative English (R-PA) and S.1024, introduced by Senator Ensign (R-NV), sought to repeal the $1500 Medicare caps on outpatient rehabilitation therapy. This year Representative English and Senator Ensign have reintroduced this legislation as H.R. 916 and S.438 with the same goal in mind. A two year moratorium of the cap was included in the Medicare Modernization and Improvement Act of 2003. If no legislative action is taken to repeal the cap or extend the moratorium and the current provision is allowed to expire on December 31, 2005, a $1500 cap will be applied by the Centers for Medicare and Medicaid Services (CMS) on January 1, 2006.

ASHT's Position:   Support the legislation and repeal the cap.

For more information about H.R. 916 and S.438 please CLICK HERE.

Direct Access

Last year, H.R. 792 and S. 493, the "Medicare Patient Access to Physical Therapists Act of 2003," were aimed at amending Medicare in order to authorize qualified physical therapists to provide services for Medicare beneficiaries without the requirement of a "primary care" physician referral. Both pieces of legislation, however, preserve the existing law that requires Medicare beneficiaries to obtain a physician referral before seeking the care of an occupational therapist. This legislation has been reintroduced in the House of Representatives by Representative Hart (R-PA) as H.R. 1333 and in the Senate by Senator Lincoln (D-AR) as S. 647.

ASHT's Position:   No formal position, although currently ASHT is carefully considering its stance on this issue.

For more information about H.R. 1333 and S. 647 please CLICK HERE.

Competitive Bidding on Durable Medical Equipment (DME)

Section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, authorizes the Secretary to utilize a competitive acquisition authority, and requires Medicare to replace the current DME payment methodology for certain items with a competitive acquisition process. This new bidding process will establish payment amounts for certain DME, enteral nutrition, and off the shelf orthotics. In addition, last year both Representative Hobson (R-OH) and Representative McCarthy (D-NY) introduced legislation that would repeal the reduction in Medicare payment for certain items of DME.  

There has been no new legislation introduced in the 109th Congress.

ASHT's Position:   Oppose the CMS regulation which allows less qualified individuals to provide DME to patients, and which may cause delay in treatments due to the necessity of a bidding process. Support legislation to repeal the reduction in Medicare reimbursement for DME.

HCPCS: Code Revision/Reimbursement

HCPCS is divided into two subsystems:   Level I and Level II

Level I:   CPT-4, a numeric coding system maintained by the AMA to identify medical services and procedures furnished by physicians and other healthcare professionals.

Level II:   Standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT-4 Codes.

There have been no new HCPCS legislation/regulations introduced this year.

ASHT's Position:   Level II "L" codes should be revised.

30 Day Rule

The 30 day rule requires that patients visit their physician every thirty days to continue treatment and therapy.

There has been no new legislation/regulations regarding the 30 day rule introduced this year.

ASHT's Position:   The 30 day rule is a barrier to effective and consistent treatment and it should be eliminated.