• News New Blog Banner

  • CMS Clarifies Therapy Cap Exceptions for Critical Access Hospital Patients

    In a meeting with APTA yesterday, the Centers for Medicare and Medicaid Services (CMS) clarified the impact of the therapy cap on patients who receive outpatient therapy services in critical access hospitals (CAHs). CMS stated that for 2013, when a patient receives outpatient therapy services from a critical access hospital, the services will count toward dollars accrued toward the therapy cap. For example, if a  patient receives $2,000 of outpatient therapy services in a CAH and upon discharge goes to a private practice to continue therapy services, the private practice would need to obtain an exception (in this case use the KX modifier).

    However, CMS clarified that for 2013 the therapy cap does not apply to outpatient therapy services provided within CAHs themselves. This means that if the patient continued treatment in the critical access hospital, after exceeding $1,900 in therapy services, there would be no need to seek an exception through the automatic process. That is, the CAH would not need to submit the claim with a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH, the hospital would not need to obtain an exception through the manual medical review process.

    APTA had been seeking clarification on this issue from CMS since the January 1 passage of the American Taxpayer Relief Act of 2012 (HR 8), which extended the current 2-tier therapy cap exceptions process through 2013. The agency advised APTA last month that it was working with its general counsel for interpretation of the legislative language.   

    Senate Report Includes APTA Comments on Self Referral

    APTA's comments to the Senate Finance Committee's May 2012 request for input from health care stakeholders on 3 areas critical to Medicare and Medicaid reforms—program integrity, payments, and enforcement—have been included in the committee's recently released report titled "Opportunities to Curb Waste, Fraud and Abuse in Medicare and Medicaid."

    Specifically, the Senate Finance Committee writes about eliminating self referral in 2 sections of the report. Under the Beneficiary Protection section, the committee notes "concern that over-broad application of the Stark law exception for physician in-office ancillary services compromises patient care by incentivizing overutilization." The committee references "increasing enforcement of existing laws, such as the Stark law" under the area titled Enforcement.  

    More than 160 stakeholders in the health care community submitted comments to the Senate Finance Committee's request. During the 113th Congress, 6 Senators plan to work with key committees of jurisdiction, the Government Accountability Office, the Department of Health and Human Services Office of the Inspector General, and interested stakeholders to develop a more detailed list of administrative recommendations and potential legislative actions.  

    APTA's comments can be found on the association's Self Referral webpage.

    Indiana PT Day Focuses on Direct Access

    More than 530 physical therapists, physical therapist assistants, and physical therapy students from Indiana gathered at the statehouse on January 30 to show their support for HB 1034, which would provide direct access to physical therapists. Over 50 legislators joined the members of the physical therapy profession for lunch and to discuss the bill. 

    State Sen Pat Miller and state Reps Dave Frizzell and Matt Ubelhor spoke to the crowd and confirmed their commitment to passing direct access legislation. Indiana is 1 of only 3 states with no form of direct access to physical therapy treatment, and the only state without direct access to a physical therapy evaluation. Many Indiana Chapter members held signs with the messages: "49 states allow you to see your PT directly … not Indiana" and "Hoosiers deserve direct access to physical therapists."

    The House Public Health Committee hearing for HB 1034 will be held February 6. The chapter is coordinating a team of chapter members to speak in support of the bill. If it is approved by the committee, the bill would then go to the full House of Representatives for consideration.

    Photos of the January 30 event are available here.