As you may recall, the Part B therapy caps were established as part of the Balanced Budget Act of 1997 (BBA), and established per-beneficiary limits on outpatient therapy coverage. In 2017, the cap limits are $1,980 for physical therapy (PT) and speech-language pathology (SLP) combined, and a separate $1,980 cap for occupational therapy (OT). However, per provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, outpatient therapy providers can furnish services above these amounts if the provider attests that the services are medically necessary under an exceptions process. The MACRA provisions also requires the Centers for Medicare and Medicaid Services (CMS) to conduct limited targeted manual medical review on services above a $3,700 per-beneficiary threshold for PT/SLP combined, and OT.
The MACRA provisions are due to expire on December 31, 2017, and without Congressional action, Medicare beneficiaries will no longer be able to receive covered services above the annual cap limits. AHCA is grateful for the efforts of the members of the House and Senate that have reintroduced and are co-sponsoring this legislation that seeks to assure that over 1 million beneficiaries, including residents of SNFs and Assisted Living Centers, continue to have access to necessary outpatient PT, OT, and SLP services.
If you have questions, please contact Dan Ciolek, AHCA’s Associate Vice President, Therapy Advocacy.
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