WASHINGTON WIRE
February 17, 2006
Issue 89
In this issue, you'll find:
- CMS Issues Exceptions to Therapy Caps
- House Energy & Commerce Committee Chairman Sets Priorities for 2006
- Power Mobility Devices Rule Delayed
- Congress in Recess until Monday, February 27, 2006
Top Story
CMS Issues Exceptions to Therapy Caps
On
Wednesday, February 15, 2006, the Centers for Medicare and Medicaid
Services (CMS) announced its exceptions policy to outpatient therapy
caps as required under the Deficit Reduction Act of 2005.
The
therapy caps limit beneficiaries to $1,760 per year for physical and
speech therapies and a separate cap for occupational therapy. However,
if a Medicare patient's therapy costs exceed one of the caps, that
patient may seek an exception through two processes. The first,
referred to as “automatic exceptions,” would not require a written
request to a Medicare carrier, but would require a modification to the
medical claim. The exception would be available to patients with one of
the 100 specific conditions listed in the CMS transmittal. The majority
of requests will most likely be automatic exceptions. The second
process, known as “manual exceptions,” would require a written request
to a Medicare carrier. The carrier would review the request to
determine if the exception is medically necessary for the beneficiary.
If the contractor approves the therapy cap exception, beneficiaries
would receive an additional fifteen days of therapy services before
being required to submit another written request.
Health Care News
House Energy & Commerce Committee Chairman Sets Priorities for 2006
House
Energy & Commerce Committee Chairman Joe Barton (R-TX) announced
the committee’s priorities for 2006 on Wednesday, February 15, 2006.
Chairman Barton stressed the importance of reforming reimbursement to
physicians, noting that Congress cannot simply continue to delay cuts
to the physician fee schedule and that reform to the payment system
must occur. Health and Human Services (HHS) Secretary Michael Leavitt
agreed to work with Chairman Barton on the reform initiatives.
Secretary Leavitt indicated that he would like to see a shift to a
system of payment based on performance.
Additionally,
Chairman Barton stated that he will make it a priority to reauthorize
the National Institutes of Health (NIH). The NIH has not been
reauthorized in fourteen years. Chairman Barton’s reauthorization
proposals would give the NIH Director, Dr. Elias Zerhouni, more fiscal
control of the Institutes and encourage cross-cutting, trans-NIH
research initiatives. Under the President’s FY 2007 budget proposal,
the NIH would receive level funding of $28.6 billion.
Power Mobility Devices Rule Delayed
Tuesday,
February 14, 2006, the Centers for Medicare and Medicaid Services (CMS)
announced a delay in the implementation of the Power Mobility Devices
(PMD) rule established under the Medicare Modernization Act of 2003
(MMA). The rule, which covers scooters, power wheelchairs and other
“power mobility devices,” would require a face-to-face consultation
with a physician and a written prescription to obtain a PMD. In
addition, the rule would require physicians to submit supplemental
medical records to the Durable Medical Equipment (DME) supplier showing
medical necessity of the device to receive reimbursement. Under the
rule, physicians would receive an additional reimbursement for the
extra time spent on related paper work. Currently, CMS will not
reimburse physicians for the add-on payment of $21.60. After April 1,
2006, CMS will reimburse this amount retroactively. CMS recommends that
physicians hold their claims until the new effective date.
Upcoming Events
Congress in Recess until Monday, February 27, 2006
For More Information
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