Budget bill ends GPCI, therapy cap issues, will extend MIPS ‘transition’

Why This Topic Matters

The legislation and budget proposals described here can affect provider payment, quality reporting timelines, therapy claims processing, and Medicare eligibility calculations. Readers in billing, compliance, and reimbursement roles need a clear view of which changes were enacted, which were delayed, and which remain proposed.

Article Sections

1. MIPS transition stalls

   Explains the extension of the transitional period for MIPS and discusses broader timing changes related to scoring and performance thresholds. The section also addresses related impacts on cost-category updates and eligibility considerations.

2. MIPS ‘services’ change

   Covers a change in how Medicare payment is determined for MIPS purposes and notes the resulting effect on provider eligibility calculations. The section also describes the types of services affected at a broad level.

3. GPCI floor reinstated

   Summarizes the reinstatement and extension of the work geographic practice cost index floor and its effect on Medicare payment adjustments in affected localities. The section also notes the retroactive nature of the change.

4. Therapy cap fixes

   Reviews changes affecting therapy payment limitations, related claims processing, and future oversight thresholds. The section also discusses payment policy changes for therapy assistants and a future claim-identification requirement.

5. Meanwhile, Trump’s budget

   Outlines selected proposals from the president’s FY 2019 budget, including drug pricing, opioid treatment, and other Medicare- and Medicaid-related ideas. The section also mentions broader health policy items raised in the budget document.