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Now, under the legislation, the cap would be permanently repealed, with a fail-safe review mechanism in place to ensure the therapy services are medically necessary.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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