Sec. 50202. REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERVICES; LIMITATION TO ENSURE APPROPRIATE THERAPY
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## SEC. 50202 REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERVICES; LIMITATION TO ENSURE APPROPRIATE THERAPY Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) is amended— ####
(1)in paragraph (1)— #####
(A)by striking “Subject to paragraphs
(4)and (5)” and inserting “(A) Subject to paragraphs
(4)and (5)”; #####
(B)in the subparagraph (A), as inserted and designated by subparagraph
(A)of this paragraph, by adding at the end the following new sentence: “The preceding sentence shall not apply to expenses incurred with respect to services furnished after December 31, 2017.”; and #####
(C)by adding at the end the following new subparagraph: > > ##### “(B) > > With respect to services furnished during 2018 or a subsequent year, in the case of physical therapy services of the type described in section 1861(p), speech-language pathology services of the type described in such section through the application of section 1861(ll)(2), and physical therapy services and speech-language pathology services of such type which are furnished by a physician or as incident to physicians' services, with respect to expenses incurred in any calendar year, any amount that is more than the amount specified in paragraph
(2)for the year shall not be considered as incurred expenses for purposes of subsections
(a)and
(b)unless the applicable requirements of paragraph
(7)are met.” > ; ####
(2)in paragraph (3)— #####
(A)by striking “Subject to paragraphs
(4)and (5)” and inserting “(A) Subject to paragraphs
(4)and (5)”; #####
(B)in the subparagraph (A), as inserted and designated by subparagraph
(A)of this paragraph, by adding at the end the following new sentence: “The preceding sentence shall not apply to expenses incurred with respect to services furnished after December 31, 2017.”; and #####
(C)by adding at the end the following new subparagraph:. > > ##### “(B) > > With respect to services furnished during 2018 or a subsequent year, in the case of occupational therapy services (of the type that are described in section 1861(p) through the operation of section 1861(g) and of such type which are furnished by a physician or as incident to physicians' services), with respect to expenses incurred in any calendar year, any amount that is more than the amount specified in paragraph
(2)for the year shall not be considered as incurred expenses for purposes of subsections
(a)and
(b)unless the applicable requirements of paragraph
(7)are met.” > ; ####
(3)in paragraph (5)— #####
(A)by redesignating subparagraph
(D)as paragraph
(8)and moving such paragraph to immediately follow paragraph (7), as added by paragraph
(4)of this section; and #####
(B)in subparagraph (E)(iv), by inserting “, except as such process is applied under paragraph (7)(B)” before the period at the end; and ####
(4)by adding at the end the following new paragraph: > > #### “(7) > > For purposes of paragraphs (1)(B) and (3)(B), with respect to services described in such paragraphs, the requirements described in this paragraph are as follows: > > > ##### “(A) Inclusion of appropriate modifier > > The claim for such services contains an appropriate modifier (such as the KX modifier described in paragraph (5)(B)) indicating that such services are medically necessary as justified by appropriate documentation in the medical record involved. > > > ##### “(B) Targeted medical review for certain services above threshold > > > ###### “(i) In general > > In the case where expenses that would be incurred for such services would exceed the threshold described in clause
(ii)for the year, such services shall be subject to the process for medical review implemented under paragraph (5)(E). > > > ###### “(ii) Threshold > > The threshold under this clause for— > > > ###### “(I) > > a year before 2028, is $3,000; > > > ###### “(II) > > 2028, is the amount specified in subclause
(I)increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for 2028; and > > > ###### “(III) > > a subsequent year, is the amount specified in this clause for the preceding year increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for such subsequent year; > > except that if an increase under subclause
(II)or
(III)for a year is not a multiple of $10, it shall be rounded to the nearest multiple of $10. > > > ###### “(iii) Application > > The threshold under clause
(ii)shall be applied separately— > > > ###### “(I) > > for physical therapy services and speech-language pathology services; and > > > ###### “(II) > > for occupational therapy services. > > > ###### “(iv) Funding > > For purposes of carrying out this subparagraph, the Secretary shall provide for the transfer, from the Federal Supplementary Medical Insurance Trust Fund under section 1841 to the Centers for Medicare & Medicaid Services Program Management Account, of $5,000,000 for each fiscal year beginning with fiscal year 2018, to remain available until expended. Such funds may not be used by a contractor under section 1893(h) for medical reviews under this subparagraph.” > .
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Sec. 50202
REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERVICES; LIMITATION TO ENSURE APPROPRIATE THERAPY
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