The Centers for Medicare & Medicaid Services (CMS) has announced greater cost-sharing protection for Medicare Advantage recipients receiving physical therapy services in 2015. As indicated on a news release from the American Physical Therapy Association (APTA), physical therapy was added to the list of services that will be protected by maximum out-of-pocket (MOOP) spending limits for beneficiaries. CMS mandates that the MOOP cost sharing for all in-network physical therapist services be set at $40.
The cost-sharing requirement includes coinsurance, co-payments, and service category deductibles, according to CMS’s Advance Notice and draft Call Letter. The greater cost-sharing protection for Medicare Advantage beneficiaries was reportedly a change adopted as a result of APTA advocacy efforts, as indicated on the APTA news release.
The APTA news release also notes that CMS announced that there will be cuts made to the 2015 Medicare Advantage program, though the extent of those cuts is not yet clear. According to information released in the CMS call letter, the cuts will be based in part on projections that anticipate a 3.55% decline in the program’s growth rate and an estimated 1.65% drop in per capita expenditures in 2015.
The final 2015 Rate Announcement and Call Letter will be published April 7. For additional information on Medicare Advantage, visit www.apta.org/Payment/Medicare/Advantage.