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Senate changes send therapy cap bill back to House

Rehab Regs, December 30, 2005

Before adopting the conference agreement on budget reconciliation legislation (S 1932) last week, the Senate amended the bill and may have created new obstacles to implementing modifications in the Medicare therapy cap, according to PT Bulletin Online. The House of Representatives, which narrowly passed the original agreement two weeks ago, must now vote on the Senate changes.

If House Speaker J. Dennis Hastert (R-IL) decides not to call the House back into session early, the conference agreement will not be completed until January, and the $1,740 therapy cap will take effect January 1, 2006, along with a 4.4% cut in payments to physical therapists under the Medicare physician fee schedule.

The conference agreement would modify the existing therapy cap to allow patients to apply to the Centers for Medicare & Medicaid Services (CMS) for additional therapy services if their treatment is expected to exceed the $1,740 cap for 2006. CMS has yet to provide details about how the exceptions process will work, and the American Physical Therapy Association is scheduling a meeting with CMS to discuss how to structure the process appropriately. The legislation leaves unchanged from current law the structure of two $1,740 therapy caps, one for physical therapy and speech language pathology and a separate cap for occupational therapy. Services provided by hospital outpatient departments will continue to be exempt from the therapy caps.

The budget agreement also freezes Medicare physician fee schedule payments at 2005 levels, preventing the scheduled 4.4% cut, and extends the phase-in of the inpatient rehabilitation facility classification criteria by adding an additional year to the transition period for the "75% rule."

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