- Therapy Caps Coalition Meeting: Exceptions Process / Steps Moving Forward
- Oct 1 Medical Manual Review
- After 10/1, CMS has been manually reviewing any beneficiary that has reached $3700 in therapy. Currently, CMS is not accepting e-forms of applications for medical review, which is causing a large backlog. The only means is fax/mail. If you hear of any issues let us know.
- CMS has been circulating letters to beneficiaries who hit the $1880 cap saying that they may not qualify for additional therapy. The curt messaging has caused some beneficiaries to cancel therapy appointments.
- Mandatory Collection of Functional Data Upcoming
- As of Jan 2013, CMS will be requiring therapists to record and collect period functional data on patients. While they have stated the reason, it’s presumably to track progress. I had voiced in an earlier meeting that we were engaged in a lawsuit that was addressing the
improvement standard but we should watch this and ensure it does not develop into another path for discrimination.
- Legislation to Extend Therapy Cap
- Historically, the doc fix (SGR adjustment) has been tied with the therapy cap extension. This year it is unclear whether it will be completed by 12/31 (the expiration date). This is due to the other LARGE looming issues, like the fiscal cliff.
- Coalition initial strategy is to just remind Congress that this issue needs attention, too. Later we will iron out the details of what will be including in the legislation.
- Congressional Advisory Committee Suggests Alternatives for Therapy Benefit
- A congressional advisor committee on Medicare, MedPAC, has come out with an initial draft of a mandatory report to restructure the therapy benefit in Medicare. It includes a suggestion to remove the cap BUT replacing it with implementing earlier mandatory manual review. Additionally, they suggest reducing the reimbursement for multiple procedure payment reduction reimbursement. This issue arose a few years ago and the rates were cut between 20-25%. They are looking to move that up to 50%.
- In the past the Society did not engage in the reimbursement issue, however, we are looking at any patient implications. The largest we see is some providers may drop out of Medicare but there is no data to support that.
Director, Federal Government Relations
National Multiple Sclerosis Society
1100 New York Avenue, NW Suite 660
Washington, DC 20016
Ph. 202.408.1500 (external)
Ph. 30103 (internal)
- New Video: Promoting Successful Outcomes in Multiple Sclerosis
Susan Bennett, PT, DPT, EdD, NCS, MSCS, Lacey Bromley, PT, DPT, MSCS
- Check out our updated Helpful Links under Clinical Page!
- Latest references under Bibliography Listing (click here):
- Language dysfunction in individuals with MS
- Neuropsychology of Multiple Sclerosis
- Confounding Factors in Multiple Sclerosis
- MS Gait, Balance and Activity
- New Video: Multiple Sclerosis Spasticity: Take Control
Produced and directed by: Cinda Hugos, MS, PT and Lois Copperman, PhD, OTR
Click on the image below to watch the video
- Video of the Fundamentals of Rehabilitation, chaired by Patricia Bobryk, MHS, PT, MSCS (click here)