Medicare Releases New Policies for 2014

On November 27, Centers for Medicare and Medicaid Services (CMS) finalized the Physician Fee Schedule and Other Revisions to Part B for Calendar Year 2014, which sets Medicare physician reimbursement rates and makes other changes to Medicare Part B. Medicare Part B covers medically necessary services and supplies needed to treat or diagnose a medical condition as well as preventive services.

Over the summer, PAN provided comments on two issues included in the draft fee schedule – Medicare therapy caps and telemedicine. The finalized fee schedule will set the therapy cap at $1,920 for 2014 and will expand the number of people eligible for telemedicine coverage. Here’s a closer look:

Medicare therapy caps
Our comments to CMS encouraged them to work with Congress and patient advocacy groups to find a permanent solution to the therapy caps. Under current law, CMS is required to place a monetary cap on the amount of outpatient physical, occupational, and speech-language therapy a Medicare beneficiary can receive. There is an exceptions process that allows beneficiaries to receive medically necessary therapy over the caps but this must be approved by Congress each year.

While the finalized fee schedule did not eliminate the cap, which will be set at $1,920 in 2014, PAN is pleased that there is significant bipartisan momentum in Congress to come to an agreement to permanently repeal the Medicare therapy caps. A permanent fix will likely not happen until early 2014, so Congress is currently considering a short-term deal that will extend the therapy caps exceptions process for three additional months while negotiations continue. If Congress does not take any action by December 31, Medicare will not cover medically necessary therapy services over the $1,920 cap. 

Have you talked to your Members of Congress about the importance of access to therapy services? Click here to contact your Members of Congress on this issue.

Telemedicine is the remote delivery of healthcare services and clinical information using telecommunications technology, such as a computer and a webcam.  For the Parkinson’s community, telemedicine has the potential to be a powerfully valuable service in terms of improving quality of life and better management of symptoms by increasing access to specialists. Learn more.

Despite the benefits for people with Parkinson’s and many other diseases, current law limits who is eligible to receive Medicare covered services via telemedicine. While PAN is working with Congress to remove these barriers, we are also working with CMS to ensure that those Congress intended to be eligible to receive services via telemedicine are covered.

PAN submitted comments to CMS in support of increasing the coverage of telemedicine under Medicare. Currently, only Medicare beneficiaries located outside of Metropolitan Statistical Areas (MSAs) are eligible for Medicare coverage of telemedicine. Given that approximately 80 percent of Medicare beneficiaries live within MSAs, this is a very restrictive policy. Under the new policy, some people who live within MSAs and whose geographical areas have been identified as lacking health professionals will be eligible for telemedicine coverage. PAN applauds CMS for working within the current laws to extend telemedicine services to more beneficiaries.


Date originally posted: December 13, 2013.