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  • Details Still to Come on Proposal to End SGR

    Details on a recently released bipartisan framework that would drop the sustainable growth rate (SGR) from the Centers for Medicare and Medicaid Services' payment methodology and shift to alternative payment models (APMs) are still being developed, and APTA will be monitoring the proposal as specifics are worked out.

    The draft being considered by the Senate Finance and House Ways and Means Committees is still in its earliest stages and lacks many important details. The framework proposes an end to the current flawed SGR system, a freeze on payment rates until 2023, and the development of a value-based performance payment program.

    As expected, the proposal as initially drafted does not address Medicare extenders, including the Medicare therapy cap, or any offsets to the cost of this legislation; however, language in the framework indicates that discussion on these issues continues, with the goal being to find bipartisan solutions. APTA is monitoring the development of the framework and will share more information once details come into focus.

    The draft framework comes at a time when APTA is urging its members to join a grassroots effort to call on Congress to end both the SGR and the therapy cap. The effort will be amplified on November 4, when physical therapists (PTs), physical therapist assistants (PTAs), and their supporters engage in a concentrated e-mail and social media effort to help legislators understand the importance of putting an end to both policies. There is still time to join this effort by signing up for the November 4 Thunderclap and finding out more about how to contact legislators.

    For more information about APTA’s grassroots campaign to stop the Medicare therapy cap and end the SGR, visit the Advocacy webpage or e-mail advocacy@apta.org.

    Updated FLR Guidelines Address Reporting on Additional Evaluative Procedures

    The Centers for Medicare and Medicaid Services (CMS) updated its guidance on functional limitation reporting (FLR) around reporting evaluative procedures that are for different limitations in addition to those currently being reported.

    The new guidance is included in the Frequently Asked Questions document (.pdf) on the CMS Therapy Services website and provides instructions on how to report these additional procedures and functional limitations while continuing to report on the primary limitations. CMS provides the following answer:

    "You should report the evaluative procedure furnished for a second/different functional limitation other than the primary functional limitation for which ongoing reporting is occurring as a one-time visit (i.e., report all three G-codes in the code set for the functional limitation that most closely matches that for which the evaluative procedure was furnished). The ongoing reporting of a primary functional limitation is not affected when all three G-codes in a code set are reported for the evaluative procedure furnished for a second functional limitation. Note: The reporting of all three G-codes for the evaluative procedure for a second functional limitation and the ongoing reporting of a primary functional limitation can both occur on the same date of service."

    APTA has updated its functional limitation reporting webpage to reflect the new information and will create a podcast about the update during the week of November 4.