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NASL Breaking News: Therapy Cap Extension Included in the Final Agreement


NASL Breaking News: Therapy Cap Extension Included in the Final Agreement

Today, conferees are signing the conference agreement that includes an extension of the therapy cap exceptions process through December 31, 2012.  We expect the House and Senate to vote on the agreement either tomorrow or Saturday. 

At this point, we have a summary of the “Health-Related Provisions in the Middle Class Tax Relief and Job Creation Act of 2012” (Conference Agreement) prepared by health committee staff and its details on the extension are vague.  The summary language is similar to the House-passed version from December in some respects.  When actual bill text is released, we will see more detail as to how the reformed exceptions process will be structured.  Also, the original House language saved money over 10 years due to extending the therapy cap to the hospital outpatient setting.  This summary does not indicate any savings, instead it indicates a cost, so it is possible that there have been some tweaks to that specific provision.

Other provisions of interest to NASL members:

· Physician Payment Rates—freezes payment rates at their current level through December 31, 2012;

·Physician Work Geographic Adjustment – extends the floor on the adjustment to the work portion of payments for physician services that account for the geographic area where a physician practices; 

·Bad Debt—phases down SNF’s ability to get bad debt reimbursed;

·Resets Clinical Lab Payment Rates—reduces payment rates for clinical lab services by 2% in 2013.

As soon as we have more information, we will send it to NASL members.  Below is the exact section from the Agreement on the exceptions process.  To view entire summary, click here

Section 3005 - Outpatient Therapy Caps – This provision extends the therapy caps exceptions process through December 31, 2012, with modifications that will require that the physician reviewing the therapy plan of care be detailed on the claim, reject all claims above the spending cap that do not include the proper billing modifier, and provide for a manual review of all claims for high cost beneficiaries to ensure that only medically necessary services are being provided.  Furthermore, the spending caps ($1,880 in 2012), which have been in effect since 2006, would be extended to the hospital outpatient department setting to prevent a shift in the site of service to higher cost settings once enforcement of the current exceptions process begins.  Exempting these services in the HOPD setting made sense when the hard therapy cap was in place, but it no longer makes sense with the exceptions process.  Additionally, HHS is required to collect data to assist in reforming the payment system for therapy services.  MedPAC is required to recommend improvements to the outpatient therapy benefit to reflect the individual needs of patients.  CBO estimates this provision would increase spending by $700 million from 2012 through 2022.

**Info taken from NASL to provide important information to our Customers and Associates.**