The 2015 Therapy Cap: Same Story, Different Year

With all of the blog space we’ve devoted to PQRS this month, it’s easy to forget that Medicare’s final rule addresses more than just our favorite four-letter acronym. But buried deep within CMS’s annual 1,000-plus-page behemoth of government jargon is one more major item of interest to those in the PT, OT, and SLP industries: the therapy cap.

First, the good news: in accordance with the Medicare Economic Index (MEI), both cap amounts—the one for occupational therapy and the one for physical therapy and speech-language pathology combined—will increase to $1,940 for 2015 (up from $1,920 in 2014). And, thanks to some eleventh-hour legislative action this past spring, the therapy cap exceptions process remains in effect until March 31, 2015. However, that silver lining might actually be a storm cloud in disguise. Why? Well, because if history is any indication, the most recent therapy cap extension will only give legislators an excuse to put off real reform until next year’s eleventh hour.

If you’re unfamiliar with the therapy-cap saga, here’s the book-jacket version: Although the therapy cap was always meant to serve as a hard limit on Medicare’s annual coverage allowance for outpatient therapy services, Congress has acted to prevent the enforcement of a true cap every year since 1999 (the first year the cap went into effect). That’s how the exceptions process came into being. This process allows therapy providers to treat above the cap when their services qualify as “medically necessary.” And while a semi-flexible cap is certainly better than the alternative, I think most therapy providers would prefer a permanent solution over the yearly scramble to pass a quick fix.

Earlier this year—before legislators put another 365-day Band-Aid on the therapy cap exceptions process—there was a pretty strong push among therapy industry advocates and congressional representatives alike to repeal the cap (as well as the exceptions process) altogether in favor of implementing a permanent solution. But, as in past years, it was too little, too late. And while the movement to nix the cap has continued to gather support—as of September 24, there were 221 bipartisan cosponsors of the House of Representatives bill (HR 713) calling for its removal—it’s going to take a lot more work to get rid of the cap for good.

So, if you’re sick of dealing with the cap, it’s time to put legislative advocacy on your radar. After all, a new crop of congresspeople will hit the hill—Capitol Hill, that is—on January 1, and the sooner you get this issue in front of them, the better our chances of success. Check out this APTA page to learn how you can make your voice heard. Because even though the beginning of the 2015 therapy cap story is the same as the 2014 edition, the ending doesn’t have to be.