Therapy Cap Repeal Part of House, Senate Budget Bills

Both the House and the Senate proposals to keep the government open and funded include a repeal of the controversial cap on Medicare-funded therapy services.

Long opposed by the skilled nursing and physical therapy industries, the rule placed a $2,010 cap on therapy services for Medicare recipients. While Congress had routinely granted exemptions to the caps, those moves required repeated bouts of cooperation from the House and Senate — which sometimes meant that the caps took effect before before Congress could issue another fix.

Now, under the legislation, the cap would be permanently repealed, with a fail-safe review mechanism in place to ensure the therapy services are medically necessary. Once a beneficiary logs $3,000 in combined physical therapy and speech language pathology services — or $3,000 in occupational therapy claims alone — the Centers for Medicare & Medicaid Services may step in to perform a review.

But not all cases will be reviewed, with CMS using a “targeted process” to determine which to select, according to Cynthia Morton, executive vice president of the National Association for the Support of Long-Term Care (NASL). Starting in 2028, that review threshold will also grow in tandem with the Medicare Economic Index.

The House passed its version of the budget bill late Tuesday; the Senate version was released Wednesday.

“This is a really big deal for patients,” Morton told SNN via e-mail. “This is historic. The House has voted to repeal a bad, anti-patient policy that has been in effect for 20 years.”

Written by Alex Spanko

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Alex Spanko
Alex covers the skilled nursing and reverse mortgage industries for Aging Media. Outside of work, he reads nonfiction, yells at Mets games from his couch, and enjoys pretty much any type of whiskey or scotch — often all at once.



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