Medicare Update

Medicare Physical Therapy Cap Update (10/3/03)

Federal District Court Judge Emmit Sullivan ruled Monday that the Centers for Medicare & Medicaid Services (CMS) could continue to enforce the $1,590 Medicare therapy cap. He found that the agency had not violated a partial settlement agreement by failing to adequately notify Medicare beneficiaries about the September 1 implementation of the cap.

Three consumer organizations representing Medicare beneficiaries filed suit against CMS in June to block enforcement of the therapy cap and the agency agreed to delay implementation until September 1 as part of a partial settlement. Plaintiffs argued Monday that Medicare had violated the terms of the settlement by failing to notify at least 90% of its beneficiaries about the therapy cap during July and August, but Judge Sullivan refused to interpret the terms of the settlement that strictly.

However, Monday’s decision does not end the legal fight. CMS and the beneficiary groups must return to federal court October 8 to argue issues related to the impact of the therapy cap on consolidated billing for patients in skilled nursing facilities and other administrative problems.

Source: Article from APTA PT Bulletin OnLine 10/3/03