Two votes!  That’s how close we came to once and for all being rid of the therapy caps.  On April 14, the Senate passed the House-passed version of the Sustainable Growth Rate (SGR) fix, better known as the “Doc Fix.”  On April 16, the President signed bill H.R. 2, officially named the Medicare Access and CHIP Reauthorization Act of 2015, into law.  There were a number of proposed amendments to the bill, including permanent repeal of the therapy caps, but they all failed for fear of returning the legislation to the House, creating further delay.  The therapy caps amendment received 58 of the 60 votes needed for passage.
The good news is the annual threat of dramatic cuts to the Part B fee schedule is finally over (the cut this year would have been approximately 21%).  In its place are a number of changes.  Most importantly, this legislation extends the therapy caps exceptions process through December 31, 2017.  Also important, the manual medical review (MMR) process, which is currently a 100% review of therapy services that meet or exceed $3,700 in Medicare payments, will change to a more targeted review.
Here are some other important elements of the legislation.

  • Services provided and paid under the Medicare Physician Fee Schedule (MPFS) will receive annual updates of 0.5% per year from 2015 – 2019
  • MPFS payment rates will remain at the 2019 level through 2025.
    • Beginning in 2019, additional payments will be available through a new Merit-Based Incentive System (MIPS) (stay tuned)
  • In 2026, those participating in Alternative Payment Models (APMs) will receive annual updates of 0.75%, while others will receive 0.25%
  • The Medicare Payment Advisory Commission (MedPAC) is required to provide reports to Congress in 2017, 2019, 2021 on spending, access, and quality for Medicare Parts A, B, and D
  • Requires wealthy beneficiaries to pay higher Part B & D premiums
  • Renews the Children’s Health Insurance Program (CHIP) for 2 years

The ten-year cost of this legislation is estimated to be $214 billion, with only $70 billion of offsets.  Offsets include market basket increases for post-acute providers limited to no more than 1.0% in FY 2018.
Again, the good news is that medically necessary therapy services that exceed the $1,940 therapy caps can be provided to Medicare beneficiaries.  I want to thank all of you who contacted their congressional leaders and asked for their support of this important legislation.
Mike Billings

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