Medicare Compliance & Reimbursement
Yes, You Still Have The Therapy Cap Exceptions Process
Industry stakeholders won’t give up the fight to eliminate cap.
Although passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a boon to overall Medicare reimbursement, your therapy reimbursement is still subject to the therapy cap — but you can use the exceptions process for another two years.
Like the Sustainable Growth Rate (SGR) formula patch, the therapy cap exceptions process was set to expire as of March 31, 2015. If the exceptions process expired, an annual hard cap of $1,940 would have been in place for therapy services effective April 1. But industry stakeholders were not hoping to extend the exceptions process, but rather to eliminate the therapy cap altogether.
Bad news: Despite a concerted, historic grassroots advocacy effort, MACRA does not end the Medicare outpatient therapy cap, the American Physical Therapy Association (APTA) announced on April 15. Instead of a full repeal, the therapy cap exceptions process will extend until Dec. 31, 2017.
Rather than repealing the annual Medicare payment caps for outpatient therapy, MACRA keeps the caps in place, according to a recent analysis by the Center for Medicare Advocacy (CMA). The law “merely extends the Medicare therapy cap exceptions process by another two years and makes revisions to the manual review process.”
“The therapy caps are one of the biggest barriers to medically necessary care faced by individuals with chronic conditions,” CMA lamented. “And since many providers are reluctant to use the exceptions process, individuals who could benefit from ongoing therapy go without.”
Not over yet: “We are of course disappointed that the therapy cap repeal effort was not successful, but thanks to the hard work of APTA members and supporters, we were able to seize an historic moment and move this issue closer to the goal line than at any time in the 18-year history of the cap,” APTA executive vice president of public affairs Justin Moore, PT, DPT said in the announcement. “We will capitalize on this energy, unity and momentum, and will never stop working for the best interests of patients.”
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