Federal Court Upholds Enforcement of Therapy Cap

Federal District Court Judge Emmit Sullivan has ruled that the Centers for Medicare & Medicaid Services (CMS) could continue to enforce the $1,590 Medicare therapy cap. He found that the agency had not violated a partial settlement agreement by failing to adequately notify Medicare beneficiaries about the September 1 implementation of the cap.

Three consumer organizations representing Medicare beneficiaries filed suit against CMS in June to block enforcement of the therapy cap and the agency agreed to delay implementation until September 1 as part of a partial settlement. Plaintiffs argued that Medicare had violated the terms of the settlement by failing to notify at least 90% of its beneficiaries about the therapy cap during July and August, but Judge Sullivan refused to interpret the terms of the settlement that strictly.

However, this decision does not end the legal fight. CMS and the beneficiary groups must return to federal court October 8 to argue issues related to the impact of the therapy cap on consolidated billing for patients in skilled nursing facilities and other administrative problems.

APTA encourages members to inform the readers of their local newspapers about the impact of the cap by writing a "Letter to the Editor." A model letter is available at APTA's Therapy Cap Resource Center .

[source: apta.org 10/3/03 ]

PREFERRED Vendor Profile— Empi

Empi designs, manufactures and markets non-invasive rehabilitation products such as electrotherapy devices for pain, neuromuscular rehabilitation, non-invasive drug delivery and their respective accessories. Other products include dynamic orthoses, cervical traction, incontinence therapy, and a neuromuscular device for anterior knee pain. They are dedicated to continuous research and development, providing superior customer service to ensure patient compliance and offering cost effective health care solutions that improve the quality of life for patients. Visit their website at www.empi.com or call 800-328-2536.

PREFERRED Network News is a PREFERRED Therapy Provider, Inc. publication produced for informational purposes and distributed to our providers and other members of the business community. Its contents should not be applied as definitive health, legal or business management advice. Readers should consult with their professional advisors prior to making any decisions based on information within PREFERRED News.

For additional copies of PREFERRED or to add other individuals to our e-FAX mailing list, please contact:

Tiffany Washko at 800.664.5240