While the last minute legislation is mostly known for the issue of the fiscal cliff and the arguments over taxes, the legislation is in large part a modified version of the Middle Class Tax Relief Act passed in April of 2012.

Taxpayer Relief Act

The bill extends the Part B Outpatient Therapy Services exceptions process through December 31, 2013, on annual per beneficiary payment limits of $1900 for physical therapy and speech language pathology and $1900 for occupational therapy. The provision continues application of the cap for services received in hospital outpatient departments through December 31, 2013, and adds a new provider category, Critical Access Hospital (CAH) outpatient departments, which will now be subject to the therapy cap provisions. This legislation continues the Medical Manual Review (MMR) process for outpatient therapy services that exceed the $3700 threshold. As such the MMR will be in effect from January 1, 2013 through December 31, 2013. (Per NASL summary)

The Multiple Procedure Payment Reduction (MPPR) will be increased to 50 percent and applied to therapy by reducing payment for practice expense of the second and subsequent therapies when therapies are provided on the same day, instead of the existing 25 percent discount. The change from the 25% reduction of the practice expense to a 50% reduction will take effect April 1st, 2013. This is not a 50% reduction in the PFS therapy codes, rather a 50% reduction of one part of the formula that creates the fee for each code. The current 25% reduction has been in place and has resulted in an overall 8-10% reduction in reimbursement for Med B therapy services.

Additionally, the bill creates a new Commission on Long Term Care to develop a plan for the establishment, implementation, and financing of a high-quality system that ensures the availability of long-term services and supports for individuals. This will be a bit partisan committee with members from the Senate, House and the White House appointed to create a 15 member committee.

Since the new congress will need to deal with the fiscal cliff within the next two months more cuts may needed to be made to pay for what they develop. As such, long term care and therapy could still see changes so lobbying to congress will continue to be very important.



Christine Kroll, MS, OTR

HTS Director of Operations