March 21, 2018

Lifting Therapy Caps Is A Load Off Medicare Patients’ Shoulders

The federal budget agreement Congress approved last month removes annual caps on how much Medicare pays for physical, occupational or speech therapy and streamlines the medical review process. It applies to people in traditional Medicare as well as those with private Medicare Advantage policies. As of Jan. 1, Medicare beneficiaries are eligible for therapy indefinitely as long as their doctor — or in some states, physician assistant, clinical nurse specialist or nurse practitioner — confirms their need for therapy and they continue to meet other requirements.

The Centers for Medicare & Medicaid Services (CMS) last month notified health care providers about the change. And under a 2013 court settlement, they won’t lose coverage simply because they have a chronic disease that doesn’t get better.

“Put those two things together and it means that if the care is ordered by a doctor and it is medically necessary to have a skilled person provide the services to maintain the patient’s condition, prevent or slow decline, there is not an arbitrary limit on how long or how much Medicare will pay for that,” said Judith Stein, executive director of the Center for Medicare Advocacy. But don’t be surprised if the Medicare website doesn’t mention the change.

Information on the website will be revised “as soon as possible,” said a spokesman, who declined to be identified. However, information from the 800-Medicare helpline has been updated. Until then, patients can refer to the CMS update posted last month for providers. Lifting the therapy caps is just one of the important changes Congress made for the 59 million people enrolled in Medicare.

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