News & Press: Legislation

SGR, Therapy Cap Update What you Need to Know for April

Monday, March 30, 2015   (0 Comments)
Posted by: Bibiana Braun
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On Thursday, March 26 the House of Representatives passed the Medicare Access and CHIP Reauthorization Act (H.R. 2) by a vote of 392-37.  This legislation included provisions to repeal and reform the current flawed sustainable growth rate (SGR) formula, but only an extension of the Medicare therapy cap exceptions process through 2017.  The Senate did not vote on the legislation and has recessed for two weeks.  

 

The Centers for Medicare and Medicaid Services (CMS) has issued guidance that they will typically hold claims for 14 calendar days, allowing Congress a short window of time when they return from the recess to come to an agreement and pass legislation to prevent cuts to payments and allow necessary therapy services to continue above the therapy cap amount of $1940.
APTA will be working with legislators over the next two weeks to ensure this passage, while also continuing the push to include FULL REPEAL of the therapy cap in a final SGR package.  We believe there is still an opportunity for a permanent solution to put this issue to rest after 18 years, but we need your help.

What You Can Do
Please keep up the drumbeat with your legislators over the congressional recess by using APTA’s legislative action center or the APTA Action App.  In addition, encourage your patients and colleagues to reach out as well to support inclusion of full repeal of the therapy cap.  Patients and nonmembers can write their legislators using the Patient Action Center.
For those of you who have already been communicating directly with Congressional staff or members, please keep touching base as these negotiations continue. 
APTA will update its resources in the coming days for guidance in the interim and will issue additional grassroots alerts on Senate action in the coming days.  Please check back for updates on the therapy cap FAQ page.

Important -  We Need Your Stories
Given the delay on congressional action, the therapy cap will go into effect next week.  Although CMS is expected to hold claims, we need to hear your stories of the patient impact of the cap.  We will share these stories with our congressional advocates to seek a permanent resolution to this issue.  Please e-mail your stories to advocacy@apta.org


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