Physical therapy services for Medicare beneficiaries would no longer be limited by arbitrary financial caps under legislation introduced recently in the Senate and House of Representatives, according to the American Physical Therapy Association (APTA).

The Medicare Access to Rehabilitation Services Act (S 46/HR 43) introduced by Senators John Ensign (R-NV), Blanche Lincoln (D-AR), Susan Collins (R-ME), and Ben Cardin (D-MD), and Representatives Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO) calls for the repeal of the Medicare therapy caps that limit coverage of outpatient rehabilitation services to $1,840 for physical therapy and speech language pathology combined and $1,840 for occupational therapy services.

“Therapy is necessary to effectively manage and confront many age-related diseases, such as stroke, Parkinson’s, and congenital heart failure,” says Ensign. “Every year in the Senate we debate this issue of therapy caps, and this year needs to be the last.”

Becerra added, “Everyday, Americans who suffer from debilitating diseases like Parkinson’s or are recovering from serious injury need medical therapy in order to reach their highest functional level. It is outrageous that in addition to focusing on their rehabilitation, they also have to worry about whether they will exceed Medicare’s monetary caps. These arbitrary caps on physical, occupational and speech therapy are incompatible with the goal of recovering these patients’ ability to function normally in their everyday lives.”

The therapy caps were originally adopted by Congress in the Balanced Budget Act of 1997. The caps reduce beneficiaries’ access to critical services by limiting their choice of providers by requiring them to pay 100 percent of the cost of care once they exceed the cap or ration their care to avoid exhausting their benefits.

Since 1997, Congress has acted to prevent implementation of the caps by passing several moratoria and authorizing an exceptions process for rehabilitation services above the financial limitation based on diagnosis and clinician evaluation and judgment. An 18-month extension of the exceptions process was included in the Medicare Improvements for Patients and Providers Act (HR 6331), which passed July 15, 2008. The exceptions process is set to expire December 31, 2009.

Lincoln says, “Therapy caps can preclude seniors from getting the care they need to maintain a healthy quality of life. I will continue my work in the 111th Congress to find a legislative solution so that patients receive the quality care they need without undue burden. As a nation, we have a responsibility to protect and support our seniors, and I remain committed to fighting on their behalf.”

“I am concerned that Medicare beneficiaries recovering from a stroke, hip fracture, or other disease or condition requiring extensive therapy will not be able to receive all of the services they need under this cap,” says Collins. “Moreover, Medicare patients will have an incentive to seek services in the hospital outpatients setting, which are not subject to the cap and are more expensive.”

Cardin adds, “Rehabilitation therapies are critical to helping so many Americans recover from injuries and debilitating illnesses. We should be helping seniors get the therapy they need so they can resume their normal lives, not putting up road blocks to their recoveries. Year after year, Congress has shown its disapproval for these arbitrary therapy caps with short-term fixes. We must take action now to eliminate them permanently.”

APTA President R Scott Ward, PT, PhD, who attended Tuesday’s swearing in ceremonies, says, “By introducing this legislation on the first day of the 111th Congress, our nation’s leaders are sending a clear message that total repeal of the caps is the best long-term solution to ensuring that Medicare beneficiaries receive the rehabilitation services they need. It’s time to end the year-to-year fixes and pass legislation that fully protects beneficiaries.”

“Congress has a responsibility to pass a permanent solution for therapy caps to ensure our nation’s consumers continue to receive much-needed treatments,” says Ross. “I am proud to join with my colleagues as an original cosponsor of this important legislation to provide long-term relief to patients and health care providers, and I will continue to advocate for its passage in the House of Representatives.”

Blunt notes, “Congress has voted time and again to temporarily fix an unintended consequence of legislation passed more than a decade ago. It’s about time that we pass a permanent fix so people on Medicare can receive the therapy their doctors recommend without having to worry about arbitrary payment caps.”

Source: American Physical Therapy Association