(ROCKVILLE, MD - February 22, 2006) The Centers for Medicare and Medicaid Services (CMS) recently issued instructions for implementing exceptions to Medicare outpatient therapy caps—exceptions that will permit beneficiaries the ability to receive speech-language pathology services above the cap. ASHA provided CMS with outcomes data from its National Outcomes Measurement System (NOMS) to assist in determining which diagnoses should be excepted.
Under the plan, CMS will allow an automatic exception for services to beneficiaries whose diagnosis requires both speech-language pathology services and physical therapy concurrently, provided all of the services are medically necessary and the need for extended services is documented.
While the exceptions plan is in effect only for 2006, it is viewed as a very positive step that may portend more good news for SLP providers over the long run.
"ASHA applauds this important step by CMS," observes ASHA President Alex Johnson. "First and foremost, it recognizes the importance of having a reimbursement system for valuable services that are truly needed by patients, as opposed to one that simply reimburses according to an arbitrary and abstract set of rules."
Johnson adds: "NOMS was useful to CMS as the agency decided which codes represented services that should be eligible for the new exceptions process. It will continue to be a very important resource as CMS weighs how to proceed past 2006. NOMS is unique, and I am pleased to represent an organization that can make such a helpful tool available to our national policymakers."
ASHA members can get further information about the therapy cap exceptions process. Meantime, they can also visit ASHA's NOMS website for more information.
A telephone seminar about the exceptions process, which is also open to non-members, will be hosted by ASHA on Thursday, March 9, from 1 - 3 p.m., EST. To register for this telephone seminar, please visit ASHA's website. For more information, please contact Ingrida Lusis, ASHA's Director of Health Care Regulatory Advocacy, via email at reimbursement@asha.org or by phone at 800-498-2071, ext. 4482.
ASHA is the national professional, scientific, and credentialing association for more than 120,000 audiologists, speech-language pathologists, and speech, language, and hearing scientists. Audiologists specialize in preventing and assessing hearing disorders as well as providing audiologic treatment including hearing aids. Speech-language pathologists identify, assess, and treat speech and language problems including swallowing disorders. For more information, go to www.asha.org or call 1-800-638-Talk.
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