Therapy Cap Fix Postponed

Budget Reconciliation legislation was complicated in the Senate as a parliamentarian maneuver by Democrats struck three provisions of the legislation before passage. This changed the bill from the House passed bill so the House will be required to vote on the Senate passed measure.  They are expected to approve it. Unfortunately, the House recessed for 2005 and is not planning on reconvening until January 31, 2006. On January 1, 2006, the Medicare cap on outpatient therapy services went into effect, as legislation has not been enacted to stop it, subsequently limiting coverage to $1,740.

The House is expected to address this legislation when it returns on January 31 and the President should sign the bill into law shortly thereafter. Provisions allowing an exemption from the therapy cap are still anticipated to take effect retroactively beginning January 1, 2006.  

In terms of the outpatient therapy cap, the FY 2006 Budget Reconciliation allows for the following: 

• Creates a process (by the Secretary of Health and Human Services) in which individuals enrolled in Medicare may request an exemption from the dollar limitation of the therapy cap. If the Secretary does not respond within 10 business days of receiving the request, it will be considered approved as medically necessary.
   
• The implementation of 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.

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