Therapy Caps Repeal Included in Bipartisan Budget Act

On Feb. 9, 2018, after some delays and political wrangling, the Senate approved the two year budget deal that had been agreed upon by Senate Leadership.  The Bill was immediately returned to the House that had previously passed their version Wednesday, Feb. 7.  The House then passed the Bill, and it was signed Feb. 9 by the President.  The measure increases discretionary spending caps imposed for FY 2018 and FY 2019, extends continuing appropriations funding the federal government until March 23, 2018, suspends the public debt limit until March 1, 2019, and includes other funding and policy provisions.

In addition to extending government funding, the bill deals with a number of extender items the Congress previously had not addressed.  A significant component of the bill that is of particular interest to Aegis Therapies, our patients and our customers is a section that repeals the Part B therapy caps permanently.  Section 50202 of the bill permanently repeals the outpatient therapy caps beginning Jan. 1, 2018. It continues to require that an appropriate modifier be included on claims over the current exception threshold indicating that the services are medically necessary, and it lowers the threshold for the targeted manual medical review process from $3,700 to $3,000.  This is certainly excellent news and removes the arbitrary caps that were first implemented in 1997!

The bill also includes language that addresses the “pay-for” related to this section by proposing a modification for payment for these services.  In short that language proposes that by Jan. 1, 2019, a modifier be established to indicate services delivered in whole or in part by a therapy assistant; that providers would be required to begin to include the modifier on submitted claims submitted on or after Jan. 1, 2020; and effective Jan. 1, 2022, payment for services so identified would be reduced by 15 percent from the prevailing payment rates.

As with any large piece of legislation, this news likely triggers numerous questions. Additionally, the legislative language often does not contain full implementation details.  Aegis Therapies will be studying the text of the legislation, and we expect that additional details will be forthcoming in the next several days and perhaps weeks.  We will be providing additional updates and details as they become more clear.

Aegis Therapies is a nationally recognized leader in contract rehabilitation and wellness services with more than 7,500 therapists and clinicians providing therapy services in over 1,400 facilities across 41 states.

The information contained in this post was prepared by Aegis, not by CMS or its contractors, and although we believe it was accurate at the time it was written/revised it may not cover all possible situations. For the most up to date information, please go to the official CMS web site:

 All content provided on this blog is for informational purposes only and should not be taken as medical, emotional or other type of advice. Aegis makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site. Aegis will not be liable for any errors or omissions in this information nor for the availability of this information. Aegis will not be liable for any losses, injuries, or damages from the display or use of this information. Each individual is unique; therapy and wellness progress and outcomes will vary depending on the individual.

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