Independent Therapy Providers Association
A Trade Association for the General Rehabilitation Industry

On February 17, 2012, the House and Senate passed the conference report for H.R. 3630, the Middle Class Tax Relief and Job Creation Act.  H.R. 3630 avoids the approaching  27.4% cut to Medicare Part B reimbursements and extends the therapy caps exceptions process through December 31, 2012.

Congress added additional requirements to the exceptions process, including:

• The use of an NPI for the physician reviewing the need for therapy;
• Requirement of the KX modifier on claims above the cap; and
• Requirement for medical manual review when therapy expenditures hit $3,700 (combined physical therapy/speech-language pathology) for services furnished on or after October 1, 2012.

The bill will temporarily apply the therapy caps and exceptions to hospital outpatient departments for services provided no later than October 1, 2012, and ending December 31, 2012. Previously HOPD were exempt from any cap.  This change will uniformly apply the cap and its extensions to allow for patient access and non-favoritism of one particular provider type over another. Extending the temporary cap to HOPD with exceptions creates a uniform system of utilization control across all outpatient settings and does not restrict access to medically necessary care.

Extending the therapy caps exceptions process offers only short-term relief.  Please visit your national organization website for direction on their PAC directives.   Most have call to action initiatives with a simple click to write letters to your appropriate member of Congress to express your concerns.  The American Speech-Language Hearing Association,   the American Physical Therapy Association and the American Occupational Therapy Association, as well as Congress have been working to development alternatives to the therapy cap the is of mutual benefit to beneficiaries and their healthcare providers.