CMS put a cap on therapy services for people with Medicare, meaning you can only use a certain dollar amount each year for therapy services before needing to pay out of pocket. The way it was written was, "such and such amount.... for OT, PT and SLP. Written that way purely because it was alphabetical order. This has since been interpreted as OT having their own individualized cap, then PT and SLP being combined to have their cap together. There have soooo many patients that need all the services, particularly that need PT and SLP, unfortunately impacted by this. They can't get as much of each service as they need compared to if each discipline had their own cap.
has no one ever filed an appeal on this???? this is ripe for one. one of my duties when i worked for dshs was sitting on program committees that reviewed, analyzed and created implementation instructions for changes of this type. a solely wording, grammar or punctuation change would have raised red flags causing us to ask for clarification from the feds as to their expressed intent because too many times the people inputting and publishing the written rules don't administer the programs so they don't realize that their actions are unintentionally changing or violating actual federal regulations for a given program. hopefully we caught it and made sure our people were correctly applying the regulation but if not-one single person could exercise their right to file an appeal that could impact everyone in the united states.