TMNews: #20: Jan 8, 2018: #StopTheCap, TRICARE, All of Us, & Our Re-Launch

It’s Monday January 8th, and we are happy to be back here at Talus Media. We’re kicking off the New Year with info on the Medicare Cap, cool news on the All of Us study, and great news for PTAs who want to work with veterans.


A hard cap is now in place for Medicare beneficiaries. Your patients will now have a limit of $2,010 for PT and OT combined for the year–the KX modifier that you typically use when patients go over the cap is no longer valid. Congress failed to pass permanent fix legislation before the end of session in December, though the legislation had bipartisan support. Congress will be back in session on January 19th; the battle to pass this legislation and find a fix to the therapy cap will resume at that time.

In the meantime, the American Physical Therapy Association has put out an FAQ on the hard cap, and is continuing to encourage both you and your patients to contact your legislators. You can visit the APTA’s Action Center.

CHIP Funding:

Some states will run out of funding for the Children’s Health Insurance Program (CHIP) in mid-January. CHIP provides health coverage for 9 million low income children, and covers PT/OT, well-child visits, and medications. Congress passed funding just before adjourning in December that was intended to fund CHIP for 3 months–a temporary measure. We interviewed Susan Effgen in November at the Academy for Pediatric Physical Therapy’s Annual Conference–she notes that many parents don’t understand the ramifications of the programs losing funding, and that it is important to educate parents on the loss coverage for therapy services. For more information from Dr. Effgen, you can find the full interview hereYou can find more info on CHIP in this NPR piece.


Physical therapist assistants have not been recognized as approved healthcare providers under the military insurance TRICARE…until now. President Trump signed the National Defense Authorization Act into law before the new year. The legislation will take some time to go into effect, but in the end your patients with TRICARE insurance will be able to see a PTA (and COTAs). You can check out our interview with Val Beuschlein on the importance of this legislation here.

All of Us:

The All of Us study will be one of the largest longitudinal studies ever imagined. The study seeks to enroll 1 million participants, and will track genetic markers and lifestyle throughout the lifespan. Currently, the National Institutes of Health is seeking ideas for the study–what research questions do you want answered with this study?

We had the opportunity to chat with Dr. Richard Shields, the 2017 MacMillan lecturer at the NEXT conference in Boston. He studies how human movement influences genetic expression (hint: it does!). His work with spinal cord injury and tracking genetic markers makes this study all the more relevant–exercise is an incredibly powerful tool. Check out his full interview here.

You can provide your research questions for the All of Us study here.

The Talus Media Re-Launch: Check out the full article here!

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