Congress has permanently repealed Medicare Part B therapy caps and permanently extended the Steve Gleason Enduring Voices Act, which authorizes the purchase of speech-generating devices (SGDs).
The measures were included in a continuing resolution passed yesterday that funds the federal government for the next two years.
Medicare Part B Therapy Cap
The resolution permanently eliminates the hard cap on how much outpatient speech-language, occupational and physical therapy each Medicare beneficiary is allowed per year. Congress has allowed an exceptions process in most of the past 20 years, but this permanent fix repeals the cap and replaces it with a more flexible targeted medical review threshold of $3,000.
Even with a threshold of $3,000, clinicians must use the KX modifier—which indicates ongoing medical necessity—when a patient’s therapy services exceed $2,010 (the level of the previous cap). If an SLP meets certain billing criteria (yet to be announced), the clinician may be required to submit medical records for some of the claims above the $3,000 threshold for review.
ASHA anticipates that the targeting criteria and review process will be similar or identical to the most recent therapy caps exceptions process. We will share the details when they become available.
Steve Gleason Enduring Voices Act
The resolution also requires Medicare to cover the purchase of SGDs permanently. Most of the people who use SGDs have neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), Parkinson’s disease and multiple sclerosis. Prior to 2015, people who used SGDs couldn’t take the devices with them to nursing homes, hospices or hospitals because the SGDs were rented, rather than purchased.
The Steve Gleason Enduring Voices Act lifted this limitation through Sept. 30, 2017; Congress eliminated the rental requirement permanently in this most recent funding legislation, allowed SGD-users to use their devices during facility stays.
To pay for outpatient therapy and SGC access, Congress made several other Medicare policy changes. ASHA will issue additional guidance and information as needed.
- The Home Health Prospective Payment System (HHPPS) will move from the current 60-day episode of care to a 30-day episode beginning in 2020. This change could result in reduced reimbursement for home-based speech-language services. Additionally, the annual payment update to HHPPS was restricted to 1.5 percent in 2020.
- The annual update to the Skilled Nursing Facilities Prospective Payment System was restricted to 2.4 percent in 2019.
- The annual payment update for the Medicare Physician Fee Schedule was revised from 0.5 percent to 0.25 percent in 2019.
The legislation also:
- Reauthorizes the Children’s Health Insurance Program (CHIP) through 2027.
- Gives additional funding to the National Health Service Corps through fiscal year 2019 to support graduate education for health care providers, including audiologists and speech-language pathologists.
- Permanently repeals the Independent Payment Advisory Board, empowered to implement spending reductions to Medicare with limited congressional oversight.
Jeffrey P. Regan, MA, is ASHA director of government affairs and public policy. firstname.lastname@example.org