Action is needed now to stop the Medicare Part B Outpatient Therapy Cap. If action is not taken now, a hard Medicare therapy cap will go into place on January 1, 2018. This could potentially impact more than 1 million Medicare beneficiaries, preventing them from receiving the therapy services they truly need. Often times, those individuals who exceed the therapy cap are those who are the most vulnerable and are in the greatest need of therapy services.
The Medicare Part B Outpatient Therapy Cap impacts occupational therapy, physical therapy and speech-language pathology services. It was first introduced in 1997 by the Balanced Budget Act (BBA) as a method to balance the federal budget. This 20-year-old policy is outdated and the decision to initially introduce it was not based on clinical judgement, quality concerns or overuse data. Congress has acted 16 times to prevent a hard cap on outpatient therapy services. Without action by Congress, Medicare beneficiaries will not be able to receive therapy services after they reach their annual cap of $2,010 for occupational therapy services and $2,010 for both physical therapy and speech-language pathology.
In October, three Congressional committees released a bipartisan framework that would permanently repeal the Medicare Part B Outpatient Therapy Cap. This framework includes measures such as utilization of the KX modifier to certify medical necessity and a targeted review of claims over a threshold of $3,000. If passed, this framework would provide significant benefits for Medicare beneficiaries, ensuring they receive needed and necessary therapy services.
We encourage you to contract your representatives today about H.R.807/S.253: Medicare Access to Rehabilitation Services Act of 2017. Utilize ASHT’s Legislative Action Center today to contact your representatives and have your voice heard!