April 5, 2011 News

Data Needed to Develop Therapy Cap Alternatives

Speech-language pathologists who treat Medicare Part B patients still have the opportunity to participate in a project designed to develop alternatives to the current Medicare outpatient therapy payment system (see The ASHA Leader, Nov. 23, 2010).

Under current law, Medicare limits the amount of outpatient therapy that beneficiaries may receive each year (in 2011, the caps are $1,870 for combined speech-language pathology and physical therapy services and a separate $1,870 for occupational therapy). Congress routinely has passed legislation to place a moratorium on the cap or to implement an exceptions process that allows beneficiaries to access medically necessary outpatient therapy services beyond the cap. The current exceptions process expires Dec. 31, 2011.

The project, Developing Outpatient Therapy Payment Alternatives (DOTPA), was developed by the Centers for Medicare and Medicaid Services (CMS) in response to calls from Congress to overhaul the therapy caps and the exceptions process. The project ultimately will develop alternatives to the current outpatient therapy payment system and possibly eliminate the need for an exceptions process.

DOTPA has developed a tool that will be used to identify, collect, and analyze information related to beneficiary need for and effectiveness of outpatient therapy services. Different versions of the tool have been developed for patients in nursing facilities/day rehabilitation settings and for those in community-based (outpatient) settings. For the past two years, ASHA has provided input to ensure that speech-language pathology services and patient disorders, deficits, and needs are adequately represented in the assessment tool.

SLPs are needed to participate in the project by using the assessment tool and reporting results. RTI International, a CMS contractor, is recruiting approximately 190 Medicare Part B therapy providers (SLPs and physical and occupational therapists) nationwide from nursing facilities, hospital outpatient departments (including day rehabilitation programs), private practices, and outpatient rehabilitation facilities and agencies. Over a period of up to six months, each participating provider will assess up to 150 Medicare Part B patients at admission and discharge using the DOTPA assessment tools.

It is critical that SLPs contribute data so that appropriate services can be provided to future patients in need of speech-language treatment. Participating providers will benefit by having their patient case mix included in data that will inform future utilization and payment rates for Medicare Part B therapy services; in addition, RTI and CMS will solicit participants’ feedback on the instrument. Participants also will gain familiarity with the tool, which may become the basis for a universal Medicare assessment instrument.

The assessment tools are available online. Information is available by visiting RTI International's website; by e-mailing optherapy@rti.org; or by contacting Brieanne Lyda-McDonald at 919-541-6695 or blmcdonald@rti.rg. 

Kate Romanow, JD, director of health care regulatory advocacy, can be reached at kromanow@asha.org.

cite as: Romanow, K. (2011, April 05). Data Needed to Develop Therapy Cap Alternatives. The ASHA Leader.


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