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End of Year Therapy Caps Update

At the end of 2017, we had hoped that there would be a vehicle for Congress to address the issue of the expiring Therapy Caps exceptions process.  But following the flurry of legislative activity the last couple weeks in December, Congress adjourned for 2017 and did not enact legislation to address what is often referred to as Medicare “extender payment policies.” These policies expired on Dec. 31, 2017 and include the Part B therapy cap exception process. This means that effective Jan. 1, 2018, Medicare Part B providers are operating under prior therapy caps without any exceptions based on patient need. We believe that it is highly likely Congress will fix this issue when they return this month and our hope is that they will fix it by the time they must address the current Continuing Resolution (extending government funding) that expires on Jan. 19.

There is a bipartisan and bicameral agreement on a policy to permanently repeal the Medicare outpatient therapy caps that is broadly supported by therapists, providers, and consumers and is awaiting potential Congressional action.  But the budgetary offsets required for that are still up in the air.  So, what now?  Congress will likely address therapy caps in one of two ways: move forward on the permanent repeal or approve a one or more year extension of the current exceptions process.  If they are not able to get final agreement on a permanent therapy cap repeal, there is an overwhelming probability they will enact a one or more year extension of the current exceptions process, as they have done several times previously.

While there will be some uncertainty for a few weeks, we feel confident that Congress will act to address this issue. Provider groups such as NASL and AHCA, with whom Aegis work very closely, have made the Centers for Medicare and Medicaid Services (CMS) aware of coverage and billing questions related to this issue and have requested they provide appropriate and timely billing guidance. We hope CMS will issue direction or guidance soon.  Additionally, we and others will continue actively working on this issue with Members of Congress over the next several weeks.

Aegis Therapies and our provider partners have found ourselves in a similar situation in prior years and we anticipate that Congress will act quickly so that this can be resolved and will result in minimal to no disruption in operations, care delivery and payment. Since the cap dollars don’t start counting until Jan. 1, and in most cases, it takes a beneficiary several weeks of therapy to reach the caps, it is highly unlikely that we would see many beneficiaries that would be impacted until late January at the earliest. In addition, for those few that may be impacted, Congress has historically applied the policy retroactively permitting CMS to pay facilities for the therapy provided over the cap threshold. This not uncharted territory.

Aegis is approaching this with a “business as usual” approach.  We will continue to appropriately identify and deliver required, medically necessary services to patients.  We will also follow our best practice to confirm with customers as to their position on this advocacy approach.

Note: On Jan. 4, 2018 Aegis Therapies became aware of a webpage regarding therapy caps posted on the beneficiary side of the Medicare.gov website that contains information that implies that the therapy cap exceptions process remains in place: https://www.medicare.gov/coverage/pt-and-ot-and-speech-language-pathology.html

Aegis Therapies does not believe this information is accurate because the hard therapy caps are in place with no exceptions process as of Jan. 1, 2018. We will continue to monitor this situation and update or remove this information from this post if we receive clarification from CMS. Additionally, please see this Medicare Learning Network article regarding therapy caps: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10341.pdf

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