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 treatment (SLT) a Medicare beneficiary can obtain every calendar 12 months. Starting in 1997, Congress voted a number of occasions to stay the caps from going into impact. Then again, on January 1, 2006, Congress allowed the treatment caps to take impact. The caps for 2015 are $1,940 – one cap for PT/SLT blended and a separate cap for OT – and as soon as it’s reached, beneficiaries who require further services and products within the calendar 12 months are accountable for 100% of the fee. Along with the caps, a guide scientific assessment is needed as soon as a beneficiary hits $3,700 (for PT/SLT blended and OT). For more info on guide scientific assessment, click on right here.

Exceptions to the Medicare Remedy Caps

To mitigate the have an effect on of the treatment caps on Medicare beneficiaries who want treatment services and products past the cap, in 2006, Congress created an exceptions procedure for services and products deemed medically important. Sadly, the exceptions procedure is brief and will have to be reauthorized by way of Congress yearly. In March 2014, Congress handed, and the president signed, a one-year extension of the treatment caps exceptions procedure. With out Congressional motion to completely repeal the caps or to increase the exceptions procedure, it’s going to expire March 31, 2015.

This 12 months, PAN will proceed to push for an enduring repeal of the treatment caps as we consider it’s the easiest way to make sure other people with Parkinson’s have get right of entry to to medically important bodily, occupational, and speech-language treatment services and products.