On October 26, 2017, leaders of the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee announced that they had reached an agreement to permanently repeal the annual limit on per-patient therapy expenditures in Medicare, often referred to as “therapy caps.”
As part of the Balanced Budget Act of 1997, Medicare therapy caps, which include services such as physical therapy, speech-language pathology, and occupational therapy, were first introduced in 1997 to reduce federal spending and balance the federal budget. On several different occasions, congressional leaders have tried to temporarily prevent the implementation of these limitations. Their most recent attempt was a provision included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established a targeted manual medical review process that was set to expire January 1, 2018. Since the passing of MACRA, Congress has asserted that a repeal of the therapy cap would be one of its priorities before the end of 2017.
Under the new proposed framework, the Medicare Part B therapy caps would be repealed beginning January 1, 2018. The new bipartisan agreement will continue the manual medical review process and the requirement of an appropriate modifier for claims submitted above the new threshold if procedures are considered medically necessary.
Numerous organizations committed to improving the quality of healthcare for Americans living with chronic conditions have applauded Congress’s efforts to resolve the issue of Medicare therapy caps.
“This agreement brings us a big step closer to ensuring our Medicare patients continue to receive the vital rehabilitation services needed to maintain their mobility and quality of life,” said the American College of Rheumatology (ACR) immediate past President Sharad Lakhanpal, MBBS, MD, in a press release on October 30, 2017.1 “The ACR has been a longstanding and vocal advocate for eliminating the Medicare therapy caps and we are pleased to see Congressional leaders come together around a bipartisan path forward to full and permanent repeal,” he added.1
Mark Parkinson, the President and Chief Executive Officer of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), also voiced the support of his organization.
“AHCA/NCAL applauds the bipartisan and bicameral efforts of the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee to advance a framework to repeal the Medicare Part B outpatient therapy caps once and for all. These caps, first enacted 20 years ago have been historically problematic, requiring Congressional patches periodically which create a cloud of uncertainty for the residents we care for, and jeopardizes the success of recent broader patient-centered quality initiatives and value-based payment (VBP) models. The proposed legislative framework to repeal the therapy caps demonstrates that the committees have listened to and acted upon the concerns and recommendations offered by AHCA/NCAL. We are encouraged that the proposed policy appears to permanently resolve this long-standing problem and will assure the timely and uninterrupted beneficiary access to necessary outpatient therapy services. We look forward to working with Congress to advance this framework into a permanent solution to repeal the therapy caps,” he said.2
Similarly, in an October 30, 2017, statement, Christina Metzler, Chief Public Affairs Officer of the American Occupational Therapy Association asserted, “We appreciate the hard work of the committees to draft this policy. We must continue to work to assure that this hard work of so many comes to fruition in law over the next months. Crafting this approach is step one. Beyond this agreement, there are many more hurdles ahead such as what legislative vehicle will be used to move this forward and how Congress will pay for it.”3
- American College of Rheumatology. Rheumatology leaders praise bipartisan framework to repeal Medicare therapy caps. Press release. October 30, 2017. www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/858/Rheumatology-Leaders-Praise-Bipartisan-Framework-to-Repeal-Medicare-Therapy-Caps. Accessed December 6, 2017.
- American Health Care Association. Long term care profession commends bipartisan, bicameral effort to repeal therapy caps. Press release. October 26, 2017. www.ahcancal.org/News/news_releases/Pages/Long-Term-Care-Profession-Commends-Bipartisan-Bicameral-Effort-to-Repeal-Therapy-Caps.aspx. Accessed December 6, 2017.
- American Occupational Therapy Association. AOTA commends congressional committee efforts to repeal Medicare therapy cap. Press release. October 30, 2017. www.aota.org/Publications-News/ForTheMedia/PressReleases/2017/103017-Therapy-Cap-Framework.aspx. Accessed December 6, 2017.