Protecting Access to Medicare Act of 2014

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This legislation addresses the following critical Medicare Part B payment and coding issues:

The new law mandates that Medicare Part B rates effective Jan. 1, 2014, which included a 0.5 percent increase for claims with dates of service on or after Jan. 1, 2014, will remain in place through Dec. 31, 2014. Without this measure, Medicare Part B rates would have been hit with a dramatic decrease effective April 1;
The new law also extends the therapy caps exceptions process through March 31, 2015. Providers of outpatient therapy services will therefore continue to submit the KX modifier on their therapy claims when an exception to the cap is requested for medically necessary services; and
There is also a provision that delays the mandated implementation of ICD-10 to no earlier than Oct. 1, 2015, with the exact length of the delay yet to be determined.

Essentially, this latest bill extends the temporary fix put forth for the first quarter of the current calendar year with the previous legislation, Pathway for SGR Reform Act of 2013 Recent LeadingAge NY guidance on calculating the 2014 calendar year Medicare Part B rates and the therapy caps/exceptions process update for 2014 is available by clicking here.

For more details also please refer to the Centers for Medicare and Medicaid Services (CMS) guidance on the Protecting Access to Medicare Act of 2014 by clicking here. In their guidance, CMS reminds providers of the following:

"The therapy caps are determined for a beneficiary on a calendar year basis, so all beneficiaries began a new cap for outpatient therapy services received beginning on January 1, 2014. For physical therapy and speech language pathology services combined, the 2014 limit on incurred expenses for a beneficiary is $1,920. There is a separate cap for occupational therapy services which is $1,920 for 2014. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached, and also apply for services above the cap where the KX modifier is used.

The new law also extends the mandate that Medicare perform manual medical review of therapy services furnished January 1, 2014 through March 31, 2015, for which an exception was requested when the beneficiary has reached a dollar aggregate threshold amount of $3,700 for therapy services, including OPD therapy services, for a year. There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services combined, and (2) occupational therapy services."

Source: CMS MLN Connects

LeadingAge NY notes that protecting the Medicare Part B rates for 2014 and extending the therapy caps exceptions process was a key focus of our recent federal advocacy efforts. While not the long term solution we would have hoped for, this is still a critical next step as we continue to pursue a final resolution. We want to thank all our members who wrote to Congress and participated in the recent PEAK Conference Hill visits for a successful advocacy effort.

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