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Now that we can safely put away the inflatable Santa, stop hearing those annoying (but catchy) holiday jingles, and most importantly: avoid eggnog for 10 months, it’s time to wish everyone a Happy New Year and get you caught up to date on the latest legislative news coming out of Washington.


First off, I am happy to report that the suspense is over in regards to an expiration of the vital cap exceptions process (background here). Unfortunately, the high stakes drama returns in just 3 months.  Yes, Washington passed a 3 month extension of the cap exceptions process for the SGR (sustainable growth rate), stopping a 20.1% cut to the conversion factor- and yes, stop me if you’ve heard this before: legislators and lobbyists are optimistic on getting permanent repeal of the therapy caps legislation passed by March 31, 2014. The short term fix also leaves in place use of a KX modifier on claims exceeding $1920 and still requires a time consuming medical manual review for claims exceeding $3700.  The extension also included a .05 % payment increase for providers and kept in place the cap requirements for Critical Access Hospitals through 2014.


Despite my gloomy tone, there are legitimate reasons a full repeal may just get over the hump this time.  For one, the cost of a full repeal has dropped significantly with the current slowdown in healthcare costs.  For another, competing House and Senate bills have been drafted with more detail than ever before and bipartisan noise has been elevated on the stupidity of the arbitrary caps. There is still the question on how to pay for a permanent fix, which despite dropping by over 100 billion still adds up to s0me serious coin.  Here’s to hoping its not done by giving short thrift to rehabilitation access and that a balanced proposal can be reached.  That being said, the current outlines of the competing bills look reasonable.  A full repeal would give a tremendous boost of morale for therapists and therapy providers, while bringing some much needed stability and certainty to patients. A quick peek at the highlights in the proposed bills reveals:


  • A freezing of rates for providers for 10 years with the possibility of exceeding the base rates by meeting certain value-based metrics and outcomes.
  • A phase out of the current crippling MMR policy in 2015 that would be replaced by a quicker decision process (10 days) and would include possible exceptions for providers that sustain low denial rates.
  • A 2015 requirement mandating all claims be specified whether treatment was from a full therapist or an assistant.
  • The creation of a new data collection system to be in place by 2017.

For a more complete picture of the proposed changes, you can go here.


For all of you out there who have a stake in this crucial struggle to bring much needed stability to our therapy community please get involved.  The APTA, AOTA, and ASHA have been doing exemplary work to bring this issue to the forefront for years and they all provide a platform for you to rally for the cause.  Another good source of information comes from the invaluable: Stop the Medicare Therapy Cap Facebook page.  The site provides solid “on the ground” information, as well as functioning as an open forum for therapists to come together to celebrate, commiserate, and just plain chat.  Until next time…