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  • Senate and House Propose End to SGR, Therapy Cap Repeal Also Discussed

    House and Senate proposals now on the table would end the sustainable growth rate (SGR) formula that has confounded adequate payment to Medicare providers since its inception. The Senate version also suggests a permanent repeal of the Medicare therapy cap. The proposals are scheduled for discussion this week.

    Both proposals—created by the Senate Finance and House Ways and Means committees—repeal the current SGR formula and freeze payment rates for 10 years. During this 10-year period providers are eligible to earn payment above the base level through value-based performance programs and alternative payment models.

    The Senate Finance Committee proposal also includes a full and immediate repeal of the Medicare therapy cap. However, manual medical review would remain in place at the $3,700 level through 2014, followed by the development of a modified medical review process beginning in 2015.

    The Senate proposal also calls for the creation of a new data collection system to replace the current functional limitation reporting system and includes language directing the Secretary of Health and Human Services to explore new payment models for outpatient therapy. The bill also requires that beginning in 2015, claims for outpatient therapy include data on whether a physical therapist assistant provided the service.

    The House Ways and Means proposal focuses solely on repeal of the SGR formula and does not include a repeal of the therapy cap or any Medicare extenders. The House committee is expected to discuss its proposal sometime this week before adjourning on Friday, December 13.

    APTA continues to work with legislators and staff on the Senate Finance and House Ways and Means committees as these proposals make their way through the legislative process. APTA will provide additional resources for members and an analysis of the impacts on the physical therapy profession after this week's discussions.


    • Any hope of doing away with MPPR? That alone would be helpful. I think we should have a review process, it will reward PTs and their patients who treat and document properly. Unfortunately, many PTs do not want to risk a review and tell their patients, "sorry you've met your cap and I have to discharge you now. Or you can pay out of pocket." Terrible! I have sent 2 reviews out this year to our RAC and both were fully approved. Don't be afraid of this process if you are doing the right treatment and documentation! Nancy Reynolds, PT Chapel Hill, N.C.

      Posted by Nancy Reynolds -> =JW\= on 12/12/2013 12:55 PM

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