NASL Article Details

Press Release

NASL Statement on Discussion Draft to Repeal the Therapy Caps

NASL, 11/3/2017

NASL Statement on Discussion Draft to Repeal the Therapy Caps

NASL is pleased that the three committees with jurisdiction over Medicare – the Senate Committee on Finance and the House Committees on Energy & Commerce and Ways & Means – have jointly agreed to and released a discussion draft that would repeal the Part B Outpatient Therapy Cap, which was enacted in the Balanced Budget Act of 1997. The NASL Board of Directors has reviewed the discussion draft, and is supportive of this language.

The discussion draft language repeals the longstanding, arbitrary cap on therapy services and institutes a program of targeted medical review for Medicare claims above a certain dollar threshold. The medical review program cited in the draft is the same program that is in place now, and that NASL members tell us is working smoothly. The draft language lowers the threshold for targeted medical review from $3,700 to $3,000, which will increase the universe of claims eligible for review by the Centers for Medicare & Medicaid Services (CMS). We expect claims for therapy provided to patients with the highest acuity levels, who most often receive care in nursing facilities and other post-acute settings, to be the focus for this targeted medical review. Still, NASL is very appreciative that the Congressional committee staff did not include a program of prior authorization of therapy services in the discussion draft.

Overall, this discussion draft represents a very positive development for both patients and their therapy providers. We recognize that the offsets for repeal of the caps have not yet been identified by the Committees. NASL will revisit our assessment of the entire package once those offsets are disclosed. In the meantime, NASL will continue to work with these Committees to advance this language on behalf of the patients most affected by the arbitrary caps on therapy services and those who care for them.