|Federal Affairs Liaison Update
In December, the Federal Affairs Liaison Committee discussed recent regulatory, congressional, and TRICARE updates.
In late November CMS released the Comprehensive Care for Joint Replacement (CJR) Model/Cancellation of Episode Payment Models Final Rule. Within the rule, CMS made 3 major policy changes. CMS reduced mandatory CJR participation from 67 geographic areas to 34 areas and now allows eligible hospitals in rural areas to voluntarily participate. CMS cancelled the acute MI, CABG, and surgical hip/femur fracture EPMs and the cardiac rehab incentive payment model that were set to begin on January 1, 2018. CMS plans to design new models with greater stakeholder input. CMS expanded the scope of clinicians eligible to receive Advanced APM bonus. To view a fact sheet on the rule, please see: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-FactSheet-items/2017-11-30.html
Congress recessed in December without addressing the Medicare therapy cap, despite the bicameral, bipartisan agreement that was announced in October. The bottom line: unless CMS determines it has any flexibility, beginning on January 1, 2018, the $2,010 hard cap on physical therapy and speech-language pathology services combined will be instituted, and the exceptions process that currently permits medically necessary services above the cap through use of the KX modifier will no longer apply. It should be noted that the hard cap will not apply to hospital outpatient clinics. Hospital OPs were not originally included under the therapy cap when it was first enacted as part of the Balanced Budget Act (BBA) in 1997. Hospital OPs were subsequently added to the cap exceptions process in 2012. However with the expiration of the exceptions process on December 31, 2017, the requirement for hospital OP to participate in the therapy cap exceptions process also expires.
President Trump signed into law the Tax Cuts and Jobs Act in December. The deductions for student loan interest stays, graduate students who receive tuition reductions and waivers won’t be taxed on the value of those programs, and deductions for medical expenses will increase.
President Trump the National Defense Authorization Act, thereby allowing PTAs to be service providers for TRICARE beneficiaries. The change will not take place until the DOD issues guidance under the new law.
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