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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.

    Mothers Today Less Physically Active Than 1960s Moms

    Today's mothers are spending an average of 12.5 hours less per week on physical activity (PA) than mothers in the 1960s—a difference that researchers are describing as a "significant reallocation" of time to sedentary activities that could contribute to a potential public health crisis.

    The findings, published in the December Mayo Clinic Proceedings, examined data contained in the American Heritage Time and Use Study, an activity log program that has captured more than 50,000 diary days and 90 behavioral categories from mothers beginning in 1965.

    Researchers divided the mothers into 2 groups—those with children between the ages of 5 and 18 (mothers with older children or MOC), and those with children younger than 5 (mothers with younger children, MYC)—and reviewed activity logs over a 45-year period, 1965–2010.What they found, according to the authors, was alarming:

    • Weekly hours of PA in mothers of older children dropped from 32 to 20.9 hours per week, with a 7 hour-per-week rise in sedentary activity (SED) to 24.7 hours a week.
    • For mothers with younger children, the decrease in PA was even more significant, with weekly PA dropping from 43.6 hours per week to 29.7. The increase in SED was slightly less than the MOC group, up by 5.7 hours per week to a 22.7 hour-per-week average.
    • Energy expenditure decreased for both groups, with the MOC group showing a 1,238 drop in weekly calories burned and the MYC group burning 1,572 fewer calories per week. To offset this decrease and maintain their weight, mothers in the MOC group would need to consume 178 fewer calories per day than mothers in the 1960s, the researchers estimated; MYC would need to consume 225 fewer daily calories.
    • Stay-at-home mothers reported almost 2 times the decrease in physical activity as working mothers and higher rates of sedentary activity.

    Researchers attributed most of the difference to a significant rise in "screen-based media use" and wrote that "with each passing generation, mothers have become increasingly physically inactive, sedentary, and obese, thereby potentially predisposing children to an increased risk of inactivity, adiposity, and chronic [non-communicable diseases]."

    CMS Issues Information on Skilled Therapy Services and Maintenance Care

    The Centers for Medicare and Medicaid Services (CMS) has issued revised portions of the Medicare Benefits Policy and Claims Processing manuals to clarify coverage of skilled therapy services in maintenance care. The revisions were mandated as a result of the Jimmo v Sibelius settlement agreement reached in US District Court earlier this year.

    In the transmittal (.pdf), CMS reiterates its longstanding policy that skilled therapy services still may be covered even in situations where no improvement is possible, including when skilled services are needed to prevent deterioration. The transmittal also contains information on the documentation necessary for coverage determinations in skilled maintenance therapy.

    APTA is reviewing the transmittal and will provide a detailed summary in the coming days.

    Join CMS from 2:00 pm to 3:00 pm December 19 for a Medicare Learning Network conference call on how the Jimmo v Sibelius agreement will affect the services provided by physical therapists. Registration is open now, but spaces are likely to fill up quickly.