On February 9 President Trump signed into law a $500 billion bipartisan budget deal passed by Congress that funds the US government through March 23, 2018 and sets the spending framework for 2019. The budget bill includes a permanent fix to the Medicare Part B therapy cap plus increased spending for the military and domestic spending.
The therapy cap has been an APTA priority since it was first established in 1997 in the Balance Budget Act. Over the past 20 years, Congress recognized the cap was a flawed policy and thus enacted a series of moratoria and an exceptions process to delay or prevent its implementation. The legislation enacted on February 9 is a permanent solution to the hard cap and forever eliminates the constant threat it posed to patients. Read More
Therapy Cap Exceptions Process
Therapy claims for outpatient Medicare Part B that go above $2,010 (adjusted annually) will still require the use of the KX modifier for attestation that services are medically necessary. The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027. While the threshold amount for medical review will be lowered, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase.
Claims that go above $3,000 will not automatically be subject to targeted medical review; only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.
Budget Compromise Affects Home Health Payment and Policy
The budget deal also incorporates items that impact home health. On the positive side it includes an extension of the home health rural add-on at current levels for 2018; it also includes varied add-on rates for rural counties from 2019 through 2022. Additionally, it includes a provision allowing home health medical records to be used to determine eligibility for home health services.
It also requires the FY 2020 market basket update for home health agencies to increase by 1.5% in 2020. However, on the flip side it requires a budget-neutral transition to a 30-day unit of service for home health services, down from the current 60-day unit of payment starting in 2020 and eliminates the use of therapy thresholds in case-mix adjustment factors. It also includes a requirement to convene at least one session of a technical expert panel to identify and prioritize recommendations for the revised payment system. Finally, it requires HHS to undergo rule making to propose and then finalize the revised payment system prior to January 1, 2020. As this was a comprehensive bill addressing multiple issues, many pay-fors were included to offset spending.
North Carolina Student Conclave LEARN. INTERACT. GET INVOLVED. Hosted by the North Carolina Student Special Interest Group
All North Carolina DPT & PTA students are encouraged to attend the NC Student Conclave!
March 24, 2018
Breakfast & Lunch Provided
Mary Duke Biddle Trent Semans Center
for Health Education
Duke University Medical Center
Durham, NC 27710