Reconciliation Bill Passes by Slim Margin

Reconciliation Bill Passes by Slim Margin

The House, on February 1, passed the FY 2006 Budget Reconciliation bill with a 216 to 214 vote, largely along party lines. This was the second time the House has voted on this bill, as the Senate made minor changes to the language which forced the House to take up the legislation again. The bill now goes to the President’s desk to be signed into law, which is essentially guaranteed.

As you may remember, the FY 2006 Budget Reconciliation contains a legislative victory for the therapy community, as provisions implement a program that fixes the outpatient therapy cap for 2006. The Budget Reconciliation’s one-year therapy cap fix includes several important provisions. First, the legislation allows those patients who reach the $1,760 cap on therapy services to request for additional services. In the appeals process, a patient, or someone on behalf of the patient, must appeal to the Secretary of Health and Human Services for additional medically necessary services. In the event that the Secretary does not respond in 10 business days, it may be assumed that the Secretary has approved of the request to exceed the $1,760 cap on therapy services. In addition to this short-term fix, the Reconciliation calls on Medicare to establish clinically appropriate code edits to identify and eliminate improper payments for therapy services.

The ASHT government relations team will update you as more information becomes available and will alert you when the Center for Medicare and Medicaid Services (CMS) has established the procedure for exemption from the therapy cap. We are currently in contact with CMS to ensure the process will be the least disruptive for your patients and your practice.  We will also post an update to the ASHT webpage.

To learn more on other injuries and conditions, link to Patient Education.