Medicare therapy services are once again subject to two caps – one combined $1,740 cap for physical therapy and speech language pathology and a separate cap for occupational therapy, announced the American Physical Therapy Association (APTA). The caps will be in effect on January 1, 2006.

"We are very disappointed and disheartened that Medicare beneficiaries will begin the New Year with implementation of a flawed policy that limits access to physical therapy," says APTA President Ben F Massey, Jr, PT, MA. "But we will not waiver in our commitment to provide the best care for our patients."

Before adjourning for the holidays, Congress was working towards a conference agreement on the Deficit Reduction Act (S. 1932), which would authorize the Centers for Medicare and Medicaid Services (CMS) to allow coverage for services beyond the cap if they are shown to be medically necessary. APTA is urging CMS to develop and implement a simple and effective exceptions process that will allow patients to receive clinically appropriate care exceeding the cap.

The budget reconciliation bill was approved by the Senate but still must be voted on by the House. The conference agreement is not expected to be completed until January, thereby allowing the therapy cap to take effect on January 1 as described in current law.

"The therapy cap discriminates against Medicare beneficiaries who are in the most need of physical therapy services," Massey explains. "APTA will continue to work with Congress and CMS to minimize the impact of these caps until we can replace them with a system that assures beneficiaries receive the clinically appropriate care they need."

Source: APTA