On October 26, 2017, the three Congressional Committees – the Senate Finance Committee and the House Energy & Commerce and Ways & Means Committees – announced a bi-partisan, bicameral agreement on policy to permanently repeal the Part B Outpatient Therapy Cap. The policy will repeal the therapy caps as of January 1, 2018, continue to require that an appropriate modifier be included on claims indicating the services are medically necessary, and continue targeted medical review of claims established by the Medicare Access & CHIP Reauthorization Act (MACRA). The threshold for medical review will change from $3,700 to $3,000. There still will be two thresholds for claim review – one for physical therapy and speech-language pathology and another threshold for occupational therapy. 

NASL has lobbied long and hard to help the Committee staff understand the destructive nature of establishing a prior authorization program for review of claims; there is no prior authorization contained in this language. Instead, the policy crafted by the Committees builds on the current program of targeted medical review established by Congress in 2015 in MACRA. By all accounts, the current medical review of therapy above the thresholds is a smooth program. The NASL Board agreed to support the language, but the Board also needs to see what else will be included in the overall legislative package. We anticipate cuts to programs to offset the cost of the therapy cap repeal. Cuts to nursing facilities and home health have been announced by the Ways & Means Committee, but no details provided. 

A copy of the language, as well as a summary and red line version that is easier to review, are available for download on NASL's Members Only resources webpage (member login is required). Please feel free to submit comments to membership@NASL.org. 

This is an extremely promising development and we are ramping up our grassroots support to push this over the finish line. To voice your support of a permanent repeal of the therapy caps, click here.