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ADVANCE Outlook: OT

Cap Exceptions Process Extended!

Published December 10, 2010 12:47 PM by Jill Glomstad

You’d think we’d all be used to it by now. The therapy caps under Medicare have been a thorn in the side of OTs, PTs and speech therapists for years now, and it seems like every December we’re back in this same boat – waiting with baited breath to see if Congress acts at the last minute to repeal or delay or extend things. It’s been a rollercoaster over the years, and not the kind anyone wants to hop back in line for.

This year relief came on Dec. 9, which in the grand scheme of things is not that last minute. In some years the legislature has waited until the absolute 11th hour to act. More than once the cap has gone into effect, only to be delay later, or to have the exceptions process mediate its impact. At the beginning of this year the cap, without the exceptions process, went into effect from January through most of March until Congress passed the Temporary Extension Act of 2010 in mid-March, which extended the extensions process retroactively to cover through until March 31. The health care reform law passed in late March then extended the exceptions process through the end of 2010.

Though President Obama has not yet signed it, the Medicare and Medicaid Extenders Act of 2010 was passed by Congress Dec. 9 and includes an extension of the exceptions process through the end of 2011. Dec. 9 also happened to be AOTA’s “Virtual Hill Day,” in which the association urged OTs to email their representatives about the cap. The bill also stopped the 25% cut to physician payments that was scheduled to take effect on Jan. 1.

Unfortunately, the new bill does not stop the Multiple Procedure Payment Reduction (MPPR). Under the MPPR rule, rehab therapists of different disciplines who see the same patient on the same day risk losing 25 percent of their PE component (now 20 percent for private practices). Only the one with the highest relative value unit (RVU) will be paid the full amount in 2011. AOTA was successful in lobbying to get the MPPR cut reduced, from 25% to 20% for certain providers, but the rule will still take effect Jan. 1.

The reason Congress has such difficulty and waits so long to pass these relief measures is because they need to pay for them first. For example, the just-passed Extenders Act is being funded by a change in a health care tax credit payback policy. According to the Senate Finance Committee, “the proposal would change the way people pay back overpayments when they have received more credit than they are eligible for because, for example, they earned more money than expected in a given year.” Until Medicare changes its reimbursement policy, chances are the cap and the exceptions process will continue to rear their ugly heads on a regular basis.

The best way to make permanent change possible is to advocate and talk to your legislators. AOTA provides plenty of resources to help you do that. Make it one of your resolutions for 2011. It will benefit you, your profession and the people you serve.

The details of the Medicare and Medicaid Extenders Act of 2010 are available via a press release on the Senate Finance Committee website  and the full text of the bill is available via pdf here.

More information is also available at AOTA’s Legislative Action Center.

For more on the MPPR, check the full ADVANCE news article.

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