Home Health & Hospice Week

HHAs that furnish Part B therapy should start counting their therapy pennies. 

Unless and until Congress declares otherwise, the oft-postponed - and much-dreaded - Medicare therapy caps are in effect.

For the period from Sept. 1 through Dec. 31, beneficiaries face a combined $1,590 limit on outpatient physical therapy and speech language pathology, and a separate $1,590 limit for occupational therapy. Those same limits will also apply over all 12 months of 2004.

The caps were included in the Balanced Budget Act of 1997 but never went into effect due to repeated postponements first by Congress, then the Centers for Medicare & Medicaid Services. They finally were slated for implementation July 1 of this year, but CMS agreed to push that back to Sept. 1 when the Medicare Rights Center and others sued, complaining of inadequate notice to beneficiaries.

On Sept. 29, a federal district judge gave CMS the go-ahead to implement the caps, turning aside plaintiffs' complaints that the agency still had not notified enough beneficiaries of the change. However, in a ruling delivered from the bench, the judge left the door open for individual beneficiaries to challenge coverage denials if they were not notified of the caps.

"The ball is now in Congress' court," says Medicare Rights Center President Robert Hayes. He says 49 senators and a majority of representatives have sponsored legislation to repeal the caps altogether. In addition, congressional Medicare conferees have tentatively agreed to delay the caps until 2005, but the question there is how long that bill itself will be delayed.

HHAs that provide Part B therapy usually do so after a home health patient is no longer homebound, but the patient wishes to continue receiving therapy at home through the Part B benefit. The caps do not apply to therapy furnished under the PPS home health benefit.