As you all know, Congress recessed on December 22 without acting on the bipartisan, bicameral agreement for a permanent fix to Medicare therapy cap. They also did not enact a temporary patch or extension of the current exceptions process. Thus, a hard cap of $2,010 on outpatient therapy services (PT/SLP combined) will be applied beginning on January 1, 2018. A separate hard cap of $2,010 will be applied to outpatient OT services. It should be noted that the hard cap will not apply to hospital outpatient clinics (OPs). Hospital OPs were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act (BBA) in 1997. Hospital OPs were subsequently added to the cap exceptions process in 2012. However with the expiration of the exceptions process on December 31, 2017, the requirement for hospital OP to participate in the therapy cap exceptions process also expires.
Our congressional champions expected Congress to introduce and pass an omnibus Medicare extenders bill in early December. This bill would have addressed a number of Medicare provisions set to expire the end of 2017, including the therapy cap permanent fix. Unfortunately, the debate over the tax reform legislation pushed nearly all other issues to 2018. On its way out of town, Congress passed another short term funding bill to keep open the Federal Government through January 19, 2018. We lobbied our champions to add the therapy cap fix to this spending bill, but congressional leadership made it clear in the waning days of the session that only a select few items would allowed to be added, the most notably being the temporary funding for the Children’s Health Insurance Program.
Congress returns to Washington on January 3rd and must adopt another spending bill by January 19th. APTA, AOTA, ASHA and our allies in the Therapy Cap Coalition will continue to keep the pressure on Congress during their recess urging them to take quick action on the therapy cap in early January. In addition, APTA reached out to CMS requesting guidance for how providers should handle therapy claims during this time of uncertainty under the hard cap. In years past when Congress failed to act and a hard cap went into effect temporarily, CMS asked providers to hold all claims until Congress enacted a fix. The fix was then retroactively applied to January 1 of that year. However we have not been able to secure an assurance that will be the case this time. We continue to seek clarification from the agency.
Our efforts over the next several weeks will include:
1) Lobbying & Grassroots Advocacy – APTA will continue our ongoing grassroots advocacy efforts aimed at members of Congress through a variety of mediums including action alerts, phone calls, paid media, and social media. APTA engaged Revolution Media this fall in targeted online advertisements aimed at social media advocacy with a good deal of success, and we intend to continue this engagement in January. Our grassroots efforts this fall resulted in over 20,000 emails aimed at members of Congress and we intend to keep this level of engagement as we move into January.
2) Member education and guidance – APTA will be providing ongoing communication to component leaders, payment chairs, practice chairs, FALs, and general membership on how to manage claims and billing during this uncertain time. We will be rolling out addition information in the coming days to assist providers and provide further details. In addition, we will continue to pressure CMS to issue a transmittal that provides guidance to providers on managing therapy claims under the anticipated temporary application of the hard cap.
3) Therapy Cap Coalition – we will continue coordinating lobbing outreach, grassroots, and media with our partners in the Therapy Cap Coalition, including ASHA, AOTA, NASL, AHCA, , and patient advocacy groups.
4) Public Relations/Media – APTA and our partners will continue to press this story with media outlets and the Capitol Hill press.
While we are hopeful that Congress will quickly address the therapy cap when they return in January, nothing is certain given the current environment on Capitol Hill. However resolution of this issue remains a top priority for us in January.
Please stay tuned for further developments. In the interim please let me know if you have any questions.
Best,
Justin Elliott
Vice President, Government Affairs
APTA