American Speech-Language-Hearing Association

Final Medicare Rates for 2014; Therapy Cap Exceptions Process Extended

(December 27, 2013)

The final analysis of the Outpatient Medicare Physician Fee Schedule (MPFS) for audiologists and speech-language pathologists is now available on the ASHA website.

On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This law prevents the sustainable growth rate (SGR) reduction of more than 20% that was scheduled to take effect January 1, 2014. Instead, the law suspends the reduction, provides for a 0.5% increase, and temporarily extends the therapy cap exceptions process through March 31, 2014.

The Centers for Medicare & Medicaid Services (CMS) released the final conversion factor for the 2014 MPFS as $35.8228, reflecting the 0.5% increase. The conversion factor is multiplied by the total relative value units (which are adjusted for geographical differences) to determine the corresponding fee.

Background

On November 27, 2013, CMS released the final MPFS and associated rules for 2014; however, the conversion factor did not include the SGR reform legislation, which was still in negotiation at the time of publication. The signature of the President finalized the rate that CMS announced December 27.

Congress continues to negotiate legislative language to permanently repeal the SGR and the therapy caps, though they have not yet determined how to finance the cost of the reform legislation. The temporary measure signed into law allows Congress additional time to develop a permanent solution to the SGR and the therapy cap. Proposals considered to date include payment for performance models, standardized data collection for therapy services, and a prior authorization system for outlier therapy services.

ASHA Resources

For additional information regarding legislative activity, please contact Ingrida Lusis, ASHA’s director of federal and political advocacy, at ilusis@asha.org. For information regarding the CMS MFPS, please address questions to ASHA’s Health Care Economics and Advocacy Team at reimbursement@asha.org.


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