WASHINGTON, DC – Bipartisan leaders of the Ways and Means Committee and the Energy and Commerce Committee today announced they have come to a policy agreement on a permanent repeal of the annual limit on per-patient therapy expenditures in Medicare, commonly known as “therapy caps.” The policy will repeal the therapy caps, continue to require an appropriate modifier is included on claims submitted over the new threshold, indicating the services are medically necessary, and continue targeted medical review of claims established by the Medicare Access and CHIP Reauthorization Act (MACRA).
“This is a major breakthrough and puts us well on our way to solving another major problem within Medicare. Like the days of SGR patches, these caps have put a strain on patients and their health care providers leaving everyone wondering when they might come into effect,” said Ways and Means Committee Chairman Kevin Brady (R-TX), Ways and Means Committee Ranking Member Richard Neal (D-MA), Energy and Commerce Committee Chairman Greg Walden (R-OR), Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ). “Arbitrary caps on these important services have never made much sense, as it is an important medical service that can both help patients avoid surgery or when surgery is needed, help them recover and regain their quality of life. Now, we must shift our work to ensuring this important policy is fully offset. After 17 years of patches we can finally deliver certainty to patients who rely on these vital services.”
In 2006, Congress created an exceptions process allowing patients to exceed the cap based on medical necessity. The cap was addressed most recently in 2015 with MACRA (H.R. 2), becoming law. A provision in H.R. 2 established target medical review of therapy caps and extended the therapy cap exceptions process until January 1, 2018.
The bipartisan, bicameral deal was struck by the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee.