Medicare Remedy Caps

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What are the Medicare Remedy Caps?  

The Balanced Finances Act of 1997 created limits, or caps, at the quantity of outpatient bodily (PT), occupational (OT), and speech-language remedy (SLT) a Medicare beneficiary can obtain each and every calendar yr. Starting in 1997, Congress voted a number of instances to stay the caps from going into impact. Then again, on January 1, 2006, Congress allowed the remedy caps to take impact. The caps for 2014 are $1,920 – one cap for PT/SLT blended and a separate cap for OT – and as soon as it’s reached, beneficiaries who require further products and services within the calendar yr are chargeable for 100% of the associated fee. Along with the caps, a handbook scientific overview is needed as soon as a beneficiary hits $3,700 (for PT/SLT blended and OT). For more info on handbook scientific overview, click on right here.

Exceptions to the Medicare Remedy Caps

To mitigate the affect of the remedy caps on Medicare beneficiaries who want remedy products and services past the cap, in 2006, Congress created an exceptions procedure for products and services deemed medically essential. Sadly, the exceptions procedure is transient and should be reauthorized through Congress yearly. In December 2013, Congress handed, and the president signed, a three-month extension of the remedy caps exceptions procedure.

In years previous, Congress has handed year-long extensions of the exceptions procedure. Then again, this yr is other – for the primary time, there’s important motion in Congress to take away the remedy caps altogether. There may be recently a invoice within the Senate that might repeal the remedy caps and change them with a machine that might permit for extra focused evaluations of remedy use as an alternative of the present arbitrary financial caps. As a result of Congress didn’t have time to move the entire repeal prior to the expiration of the exceptions procedure, they handed the three-month extension to permit for extra time for settlement within the New 12 months. Click on right here for more info on Medicare remedy caps repeal.

PAN is delighted {that a} everlasting repeal of the Medicare remedy caps may well be inside succeed in for the primary time in just about twenty years. Along with running with Congress on their newest remedy caps proposal, PAN additionally recommended the Medicare Get admission to to Rehabilitation Products and services Act of 2013 (H.R. 713/S. 367), which might take away the caps altogether. We’re dedicated to creating get right of entry to to medically essential bodily, occupational, and speech-language remedy a truth for folks with Parkinson’s.