Therapy cap survives via congressional inaction

The last active congressional week of the year came and went without any action on the therapy cap issue, set to expire on December 31. Beginning Jan. 1, 2018, the current exceptions process used to provide medically necessary therapy services above the $2,010 Medicare cap on will no longer be used.

The exceptions process used the KX modifier to establish medical necessity for physical, occupational and speech-language pathology (SLP) therapy services. In lieu of an extension or an alternate system, therapists could be limited to the 2018 therapy cap with no way to provide additional care in special circumstances.

The inaction is a disappointment to therapy providers, especially since Congress had discussed an alternate system in late October—one supported by the American Physical Therapy Association (APTA) , the American Occupational Therapy Association (AOTA) and others. The new suggested system would have scrapped the therapy cap and instituted a system of Medicare extenders in its place, but Congress has not yet enacted the idea.

“Congress’ inaction creates the worst-case scenario for patients and providers,” said APTA President Sharon Dunn, PT, PhD, in a news release. “Medicare patients will start the new year unsure if they will receive medically necessary care. This inaction by Congress means arbitrary barriers, stress for patients and their families, and disruptions for providers.”

Congress returns from the winter recess on January 19, when therapy associations hope legislators will make the therapy cap discussion an early priority.  “Congress must make repeal of the therapy cap a priority when they return, before anyone is denied crucial therapy services,” notes an AOTA position statement.

Meanwhile, therapy providers await guidance from the Centers for Medicare & Medicaid Services on therapy cap implementation for 2018 in lieu of a congressional solution.

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.