Medicare’s Therapy Cap: What you need to know

Now that the exceptions process for Medicare’s therapy cap has expired, therapy patients and providers are wondering what’s next. Medicare’s annual maximum allowance for outpatient rehab is absurdly low. A patient receiving both physical and speech therapy can reach the limit in just one month.

Background

In 1997, Medicare instituted a cap on how much they’d pay for outpatient rehabilitation services per year. Until December 31, 2017, the law included a 2-tiered exceptions process to allow more coverage if Medicare found the services “reasonable and necessary.”  As of today, Congress has not extended the exceptions process, nor have they repealed the cap altogether.  This could theoretically cost patients thousands of dollars in out-of-pocket therapy costs over 2018.

What you should know

Earlier this week, CMS announced that it is holding medically necessary claims exceeding the cap for 20 days. They are not denying such claims outright, in the hopes that something will change in the meantime. If Congress takes no action, the cap will become a “hard cap” — and patients will be responsible for all outpatient therapy above the limit for the rest of the year.

Keep in mind that if you are receiving sub-acute care under Medicare Part A, the cap does not apply. Your inpatient rehabilitation stay covers your required therapies as part of your treatment plan.

If you think the therapy cap may affect you, speak with your therapist to find out more.

What is the definition of “Sub-acute care”?

 

 

Specialty Care at Regency Nursing & Rehabilitation

 

Sub-acute care provides a comprehensive program of care for a person who has had an “acute event” resulting from an injury or illness; has a determinable course of treatment; and does not require intensive diagnostic or invasive procedures. General accreditation standards exist, and sub-acute care units are staffed by registered nurses.

The Regency Nursing & Rehabilitation Centers in New Jersey, are leading experts in sub-acute care.

How to Be A Parent to Your Parent

The family is meeting to discuss Mom. She’s fallen twice in the last two months and seems a little disoriented and mildly confused lately. She seems to be losing weight too. She’s definitely not taking care of herself – or her home – as she used to. The discussion becomes heated. Snippets of conversation can be heard: “nursing home, retirement residence, respite, hospice…” You think to yourself, I’ve heard many of these terms but I don’t know what they all mean. I don’t know what care is right for mom. I certainly don’t know where to begin.”

Now picture this:

The phone rings. It’s 10:30 at night. Immediately you begin to worry. It’s Mom. She’s fallen again for the second time this year. You realize that it’s just not safe for her to live on her own anymore. The next fall may result in serious injury. But what are the options? You ask yourself, “What decisions can I make that will benefit my mother and ensure her happiness?”

The scenarios above are replayed every day in a thousand different forms in homes throughout the country.

Children are never prepared to be parents..

The role of bringing new life into the world and the responsibility that comes along with it, can be overwhelming regardless of the books you have read, or the classes you’ve taken. Yet, most of us become parents and learn as we go, growing right along with our children.

Just as we may feel unprepared to parent our own children, we are even less prepared for a second, important parenting role – that of being a parent to our own parents. These are the people who brought us up, taught us about the world, gave us values and influenced our views. In short, these are the people who are largely responsible for who we are. They have always been Mom and Dad. We have always been the child.

Know however that you are not alone. There are options to choose from that will provide your loved one with an environment that will enrich his or her life while allowing them the opportunity to rehabilitate themselves and/or to live in security and comfort.

The following are some choices available for senior care today, with brief descriptions of what they offer:

Chore services: Volunteers buy groceries, vacuum, run errands, etc.

Home visitors: This includes meals-on-wheels, story reading, companionship.

Adult Day Care: Daytime activities suitable for seniors, lunches, therapy, games.

Home Health Care: Nurses, physical therapists, and dieticians provide in-home services.

Rehabilitation programs: These provide extensive physical, occupational and speech therapy in their offices.

Continuing care retirement communities/continuing care centers: Designed to meet the changing needs of residents, some offer services ranging up to skilled care off-site.

Assisted living centers: These offer some assistance with eating, bathing and other activities of daily living.

Nursing facilities: These offer all encompassing care including around-the-clock nursing, rehabilitation and physical therapy on-site. All in a healthy emotional and social setting with immediate access for health care needs.

This wide variety of care choices can seem confusing at first glance. They should be viewed, however, as a continuum of care, designed for the varying needs of seniors. They begin with a minimum of help, such as assistance with chores, or social activities ofered at adult day care centers, and continue on to more encompassing care, such as that offered at nursing facilities.