House Passes Bill to Fund Government, Repeal Therapy Caps

Drew Thies

The House Tuesday evening voted on bill that funds the U.S. government until March 23, extends important Medicare policies, and permanently repeals the Medicare cap on therapy services.

The legislation repeals Medicare Part B outpatient therapy caps retroactively to January 1, 2018. Without repeal of the therapy caps, revenue and quality of care could suffer significantly. AHCA estimates, without repeal, SNFs’ Part B therapy revenues would decline more than $811 million per year (37% of total Part B payments).

SNF Requirements of Participation require maintaining resident function at the highest practicable level.  However, most long-term residents are on Medicaid or otherwise may have limited funds and cannot pay privately for therapy services.  This could stress SNF nursing staffing further to address the functional needs of these residents if therapy is not an option.

The legislation also permanently restores the limited targeted post-pay medical review program established under the Medicare Access and CHIP Reauthorization Act (MACRA). The program lowers medical review pool threshold for annual beneficiary covered charges from $3,700 for PT/SLP services combined or OT services to $3,000 and limits annual funding for these reviews to $5 million annually.  This eliminates RAC reviews, prior-authorization and pre-pay reviews, as well as 100% review programs.

Issues unrelated to Medicare policy cloud the bill’s path to passage, though the health care aspects of the package are likely to remain in any funding bill that passes both the House and Senate. Republicans will need Democratic support to break the 60-vote filibuster in the Senate and the bill passed on nearly a party-line vote in the House.

Democrats in the Senate disagree with how the spending bill extends defense spending for a year, while only funding domestic programs through the March deadline. There are reports that Congressional leadership is working on a larger deal that matches non-defense spending to defense spending, as well as solves other budgetary items, such as the debt ceiling.

In whatever form it takes, Members of Congress will have to come to an agreement soon. The deadline to extend federal government funding is Thursday, February 8.