Healthcare Business News

AHCA sees chance to address payment caps, RUG-IV

By Jessica Zigmond
Posted: November 8, 2010 - 4:45 pm ET

The association representing skilled-nursing facilities said it sees opportunities to include two of its key issues—outpatient therapy payment caps and the patient classification system known as RUG-IV—if Congress pushes through either stand-alone legislation that addresses physician payment or a tax extenders bill.

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“If they do have a doc fix, we can put our stuff on that vehicle,” Bruce Yarwood, president and CEO of the American Health Care Association, said in a roundtable discussion in Washington on Monday.

The AHCA supports a repeal of the outpatient therapy payment caps, which since 1997 have placed annual limits on outpatient rehabilitation services such as speech language pathology, physical therapy and occupational therapy. In 2005, the Deficit Reduction Act mandated that the CMS develop an exceptions process for certain Medicare beneficiaries who exceed this cap, which currently stands at $1,860 for either physical and speech language therapies combined, or occupational therapy alone. Earlier this year, the AHCA reported in an issue briefing that this exceptions process was only intended as a “stop-gap measure,” and that the group supports a repeal of the therapy caps in the long term.

The other issue relates to the resource utilization groups. According to the AHCA, the Patient Protection and Affordable Care Act pushed back implementation of RUG-IV, a delay the group said has caused payment problems for providers. Both Yarwood and Dave Hebert, AHCA’s senior vice president of policy and government relations, said in the briefing that the group has not seen opposition—either from Congress or the administration—on these issues, and that potential new legislation provides more chances to include these provisions.



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