Legislation Affecting Therapy Coverage

At Infinity Rehab, we actively advocate on behalf of therapists and those who we serve. A component of that advocacy is relaying important information about the access of therapy services. Below is an update from the American Health Care Association and the National Center for Assisted Living detailing an upcoming legislative change that may affect access to physical therapy, occupational therapy, or speech language pathology services.

AHCA and NCAL are supporting an extension of the current cap exceptions and have worked with a coalition of patient, consumer, and healthcare provider organizations to identify simple and practical process improvements that were submitted to Congress on October 18, 2013.

Click here to alert Members of  the Senate Finance, House Ways and Means & Energy and Commerce Committees to the suggested changes.

For more details see the full description from AHCA below.

 

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Access to Therapies Threatened Take Action!

Tell Congress to Fix the MMR

As you are represented by a Member of Congress on Senate Finance, House Ways & Means or Energy and Commerce Committees, we ask that you communicate an important message regarding therapy services for our patients.

Medicare Part B physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services enable patients to restore or maintain their highest level of functional independence following an illness or injury. These cost-effective services help prevent hospital admissions, institutionalization, and facilitate an individual’s return to community living following an inpatient stay.

Current law limits the annual Part B therapy benefit to a fixed dollar amount (therapy caps), however, since 2006, Congress has enacted an exceptions process to ensure that beneficiaries receive necessary therapy services beyond the caps.

As part of the 2012 American Taxpayer Relief Act, another therapy cap extension was provided, but this time included a new requirement. Congress required the Centers for Medicare and Medicaid Services (CMS) to conduct manual medical review (MMR) when a beneficiary’s annual Part B therapy expenditures reached $3,700 for OT services, or PT and SLP services combined. When the cost of a beneficiary’s therapy services reaches this arbitrary threshold, Medicare contractors are required to manually review each claim. The therapy caps exceptions process and the related MMR process are currently set to expire December 31, 2013.

While Congress intended for the MMR process to be completed within a brief ten day window to avoid disruption of care, the process implemented by CMS has been an administrative nightmare. It has been over a year since the MMR process was implemented in October 2012, yet providers receive inconsistent and inefficient instructions, often wait weeks to months beyond the required ten day review window to receive a payment decision and often wait even longer to receive payments.

Until an appropriate patient-centered alternative payment model for Part B therapy services is implemented, AHCA supports a Congressional extension of the current Part B therapy cap exceptions process, along with necessary safeguards to prevent against inappropriate therapy utilization.

AHCA has worked closely with a coalition of patient, consumer, and healthcare provider organizations to identify simple and practical MMR process improvements, which were submitted to the Congressional committees of jurisdiction on October 18, 2013. Completing this alert will send those three improvements to Members on Senate Finance, House Ways and Means & Energy and Commerce Committees.