Reps. Roy Blunt (R- MO), Phil English (R-PA), Ben Cardin (D-MD) and Frank Pallone (D-NJ) on Sept. 19 introduced legislation to extend the Medicare exceptions process for therapy services. The Balanced Budget Act of 1997 set an annual per beneficiary cap of $1,500 on occupational therapy services and a separate combined cap of $1,500 on physical therapy and speech-language pathology for Medicare Part B enrollees. The caps, from which hospital outpatient services are exempt, were raised to $1,740 this year to adjust for inflation.
As part of the Deficit Reduction Act of 2005, Congress created a clinically based exceptions process to the caps. The Securing Effective and Necessary Individual Outpatient Rehabilitation Services Act (H.R. 6132) would extend that exceptions process for one year, giving the Centers for Medicare & Medicaid Services and Congress time to seek a permanent fix. Blunt, the House Majority Whip, noted, "The provision we included in the Deficit Reduction Act is working so far, and should be extended. It is helping to provide more accurate information about the therapy needs of Medicare patients so that we can set up a fair system for reimbursement, not one driven by arbitrary numbers."
[ via AHA News Now ]
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