Medicare Therapy Cap Exception

Aurora

11 Posts
 
Posted - 02/08/2006 :  17:41:21  Show Profile  Reply with Quote
Just wondering if anyone out there knows what the update is in regards to the therapy cap exception? I know the legislation gives CMS 10 business days in which to respond to the request for an exception but legislation doesn't provide guidelines or standards in approving this process or determination of medically necessary.

NelsonA

3 Posts
 
Posted - 02/09/2006 :  12:25:48  Show Profile  Reply with Quote
To my knowledge I haven't heard of anything as well. I stay up to date by visiting the APTA web site. There is a little article on this on the APTA site as follows:

APTA, CMS Discuss Therapy Cap Exception Process
Center for Medicare Management Director Herb B Kuhn told APTA this week that he intends to move quickly to implement a new therapy cap exception process as soon as Congress passes legislation providing the statutory authority. In a letter to Congress 2 days after meeting with APTA, Kuhn said the agency is exploring process that would provide automatic exceptions for patients meeting certain criteria, while allowing patients who do not meet the criteria to apply for an exception. Kuhn also indicated that the agency believes the exception process will retroactively include services provided since January 1, 2006, and that Medicare contractors will be responsible for administering the exceptions process.

APTA urged Kuhn to provide automatic exceptions for Medicare beneficiaries who obviously will require physical therapy services in 2006 exceeding the $1,740 cap. For patients who do not meet predetermined criteria for automatic exceptions, the Association urged the agency to establish a simple process for physical therapists to attest that a patient’s diagnosis, comorbidities, or circumstances justify an exception from the cap. APTA offered to assist Kuhn and his staff at the Centers for Medicare & Medicaid Services (CMS) in defining the exceptions and in educating physical therapists and patients about the application process.

NelsonA

3 Posts
 
Posted - 03/10/2006 :  12:54:18  Show Profile  Reply with Quote
FYI- per APTA website in regards to exceptions for Medicare cap

The Centers for Medicare and Medicaid Services (CMS) released three transmittals to Medicare contractors February 13 describing a new exception process for Medicare beneficiaries to obtain coverage for medically necessary services if their treatment is expected to exceed the $1,740 cap in 2006. The new exception process, authorized by Congress as part of the Deficit Reduction Act (S. 1932), will be implemented March 13.

The following resources should be helpful:

-CMS released a Fact Sheet on February 15 which clarifies the exception process
-APTA has prepared a brief summary of the exception process
-APTA Detailed Summary of the exception process
-CMS Medlearn Matters Article on the Exceptions Process
-Patient Frequently Asked Questions (FAQ) about the exception process
-PT Frequently Asked Questions (FAQ) about the exception process

The recently enacted budget legislation leaves unchanged from current Medicare law the structure of two $1,740 therapy caps, one for physical therapy and speech language pathology and a separate cap for occupational therapy. Services provided by hospital outpatient departments will continue to be exempt from the therapy caps

You can find out more at APTA site.

This cap doesn't apply to physical therapy provided by hospitals.