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  • APTA Advocacy Sparks Medicare Advantage Beneficiary Protections for PT Services in 2015

    The Centers for Medicare and Medicaid Services (CMS) announced greater cost-sharing protection for Medicare Advantage beneficiaries receiving physical therapy services in 2015, a change adopted as a result of APTA advocacy efforts.

    The association's work to reduce copayments for physical therapist services in Medicare Advantage plans resulted in the addition of physical therapy to the list of services that will be protected by maximum out-of-pocket (MOOP) spending limits for beneficiaries. In its Advance Notice and draft Call Letter (.pdf), CMS mandates that the MOOP cost sharing for all in-network physical therapist services be set at $40. This cost-sharing requirement includes copayments, coinsurance, and service category deductibles.

    CMS has also announced that there will be cuts made to the 2015 Medicare Advantage program, although the extent of those cuts is not yet clear. According to information released in the call letter, the cuts will be based in part on projections that anticipate a 3.55% decline in the program's growth rate and an estimated 1.65% drop in per capita expenditures in 2015.

    CMS will accept comments on the call letter until March 7. APTA plans to submit comments on behalf of its membership. The final 2015 Rate Announcement and Call Letter will be published April 7.

    The association offers resources that help explain the program at its Medicare Advantage webpage.

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