In 1997, the Balanced Budget Law set an annual Medicare expenditure threshold, or a therapy cap, for outpatient Physical Therapy, occupational therapy and speech language pathology services covered by Medicare Part B. Facilities affected by the therapy cap included : private practice, doctors' offices, skilled care facilities, rehabilitation institutions, comprehensive outpatient rehabilitation facilities, critical access hospitals, and outpatient hospital departments. For 2014, the number of therapy stamps was $ 1920 for physical therapy and combined speech pathology. $ 1920 apart is allowed for occupational therapy services. Beneficiaries listed in the Medicare Advantage plan are not subject to therapy hats unless the plan chooses to apply the cap.
Beginning in 1999, Congress placed recurrent moratoria on Therapeutic Cap until 2006. In 2006, the exclusion process was enforced through the Deficit Reduction Act of 2005. The exclusion process allowed for additional "medically required medical services" up to $ 3,700 after which, medical review manual is required before further payment is given. Once the cap is reached, the patient is required to pay a pocket for further services. Without further legislation, the therapeutic exception process will expire on March 31, 2015. At this time, hospital-based outpatient clinics will no longer be subject to therapy caps.
Video Therapy cap
Controversy
Some associations and medical organizations including the American Physical Therapy Association and the American Occupational Therapy Association have lobbied against therapy because the bill restricts disabled parents, stroke patients, and other severe cases of receiving therapeutic treatments.
Another controversy is the original bill of combined physical therapy and shared speech therapy that allows only sharing $ 1810 per calendar year for both therapeutic services. This error has not been corrected by Congress, increasingly limiting outpatient therapy services to outpatients.
Maps Therapy cap
Study
The Government Accountability Office has concluded through independent studies that the therapy caps do not meet the needs of the patients.
The Study and Report on the Utilization of Outpatient Therapy by the Medicare and Medicaid Service Center (CMS) released in September 2002 concluded that older patients needed more therapy than hat permitted: "women, older, minority patients live in specific geographies, needing services from institutional providers and suffering from complex medical conditions are more likely to require more outpatient outpatient services than the general outpatient population. "
The American Heart Association concludes that Medicare hats are burdening the government with more money in the long run, especially for stroke patients. According to their study, arbitrary hats on rehabilitation therapy punish stroke patients who often undergo extensive rehabilitation programs that are needed. More than 5.4 million Americans, including 4.4 million people with Medicare, live with stroke consequences. Failure to treat and rehabilitate stroke patients at a cost of $ 21.8 billion per year in lost productivity and disability costs.
A 2011 study resulted in a comprehensive cost analysis for outpatient therapy services provided to individuals after a stroke. This study shows the average cost of outpatient therapy services is $ 11,689 for the first year after a stroke. This amount is between 66-73% of total outpatient care costs, including drugs, for 1 year after stroke.
The independently prepared use report for CMS shows patients with diagnosis including stroke, cognitive deficit, diabetes, multiple joint degeneration, previous joint replacement, Parkinson's disease will require therapeutic services beyond what is covered by a therapy cap.
References
Source of the article : Wikipedia
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