Initial Medicare Part B Rates for 2015

The Centers for Medicare and Medicaid Services (CMS) released a fact sheet on the Medicare Physician Fee Schedule (MPFS) for 2015 that includes Medicare Part B rates paid to nursing homes and home health agencies for ancillary services. As currently posted, the MPFS includes an average 21.2 percent reduction in rates effective April 1, 2015. Legislation passed in the early part of this year extended the 2014 rates into the first quarter of 2015 instead of the usual Jan. 1 effective date.

Members are advised that for several years now CMS has been mandated to publish initial Medicare Part B rates that include a significant reduction based on the current Sustainable Growth Rate (SGR) formula. Policy and lawmakers generally acknowledge that the SGR methodology is flawed and Congress has always intervened to override the otherwise negative rate adjustments of the past few years. It is unlikely that Medicare Administrative Contractors will be updating payment files until it becomes clear as to whether or not Congress will once again intervene. 

LeadingAge NY analysis of the proposed rule for 2015 is available by clicking here. An initial review indicates that the recent release is consistent with the proposed version. LeadingAge NY will be carefully reviewing the final version and advising members regarding any changes and the final rates. Again, it may be premature at this time to assume that the rates as just published will be the final rates effective April 1, 2015. Based upon our experience of the past few years, LeadingAge NY has been advising members to budget 2015 Part B rates level with 2014.

The Medicare Part B outpatient therapy cap for Occupational Therapy (OT) is $1,940 for 2015, and the combined cap for Physical Therapy (PT) and Speech-Language Pathology Services (SLP) is $1,940 for 2015. This is an annual per beneficiary therapy cap amount determined for each calendar year. Exceptions to the therapy cap are allowed for reasonable and necessary therapy services. Per beneficiary, services above $3,700 for PT and SLP services combined and/or $3,700 for OT services are subject to manual medical review. The current therapy caps exception process will expire as of March 31, 2015 unless Congress acts to renew it.

The pre-publication version of the final rule is available by clicking here.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827