MedPAC Recommends Severe Cuts to Medicare Outpatient Therapy- Read More
During their meeting on November 1, 2012 the Commissioners of the Medicare Payment Advisory Commission (MedPAC) voted unanimously in favor of significant cuts and changes to Medicare outpatient therapy. MedPAC was charged by Congress in the Middle Class Tax Relief (Public Law 112-96) and Job Creation Act of 2012 to report to Congress by June 15, 2013 on improved Medicare therapy benefits. The report was pushed up to provide recommendations to Congress before they addressed any legislation related to the cap before the end of the year.
MedPAC recommendations would make many changes to the therapy benefit but most importantly they suggest avoiding a hard cap by implementing the following recommendations:
- Lowering a soft cap to $1270 and having all claims above that threshold subject to manual medical review.
- Increasing the Multiple Procedure Payment Reduction (MPPR) on the practice expense portion of therapy payments from 20% in private practice and physician offices and 25% in institutional settings to a uniform 50%.
- Permanently extending the cap to hospital outpatient setting.
- Use a uniform tool to collect functional data that would be used to inform payment.
AOTA is continuing to analyze the recommendations and has already begun to raise concerns over several of the recommendations. Additional information and analysis as well as AOTA’s official response will be available soon and posted for Members.
AOTA is also moving forward with meetings on Capitol Hill with Committees of Jurisdiction in order to share AOTA’s thoughts on ways for Congress to move forward with an extension of the exceptions process before the end of the year. AOTA is working independently and in coalition with partners including other provider and consumer groups to promote access to occupational therapy and rehabilitation services for Medicare beneficiaries. A series of meetings with key Members of Congress and Committee staff are underway so that the voice of the profession is heard clearly on the Hill.
In addition the 2013 Medicare Physician Fee Schedule Rule was released today and AOTA Regulation and Reimbursement staff are working on analyzing this important rule. Detailed analysis and comment will be available shortly.