The current financial caps are set at $1,740 for physical therapy and speech language pathology combined and $1,740 for occupational therapy. Without action by Congress, the exceptions provision adopted as part of the Deficit Reduction Act of 2005 (allowing Medicare beneficiaries needing care above the capped amount to apply for exceptions) will expire on December 31, 2006. This could leave many senior citizens and people with disabilities who need physical therapy care the most facing a choice between forgoing necessary care or paying 100 percent out of pocket when their Medicare coverage runs out.

"The therapy cap discriminates against Medicare beneficiaries who are in the most need of physical therapist services," says APTA President R Scott Ward, PT, PhD. "Data show that patients with stroke, hip fracture, Parkinson's disease and other conditions that require extensive rehabilitation are most likely to be affected by the Medicare therapy caps. While legislation repealing the therapy caps would solve this problem once and for all, allowing the exceptions process to continue beyond 2006 will help protect Medicare beneficiaries from the effects of a therapy cap, even if it is a short-term solution. We urge the House and Senate leaders to act on the therapy caps this year."

Legislation to completely repeal the therapy caps, The Medicare Access to Rehabilitation Services Act of 2005 (HR 916/S 438), has strong bipartisan support in both the House and the Senate. Senators John Ensign (R-NV) and Blanche Lincoln (D-AR) introduced the Senate legislation and Representatives Phil English (R-PA), Ben Cardin (D-MD), Roy Blunt (R-MO) and Frank Pallone (D-NJ), introduced the House legislation.

"It would be irresponsible to set an arbitrary cap on how much therapy a Medicare beneficiary can receive. The Medicare outpatient therapy cap ignores the health needs of our senior population - especially the oldest and sickest. Therapy is crucial for the successful rehabilitation of seniors suffering from conditions such as stroke, Parkinson's disease and congenital heart failure. Whatever limits are placed on their therapy options are also placed on their chances for recovery. If Congress fails to act this year, the arbitrary therapy caps will return on January 1, 2007, and will result in restricted access to rehabilitation services," says Ensign.

"The therapy cap is unfair to our most vulnerable seniors and disabled Americans," says Lincoln. "I have supported complete repeal of the therapy cap since it was first enacted. While repealing the arbitrary caps is the best option, extending the current exceptions process beyond 2006 will protect Medicare beneficiaries from the arbitrary therapy caps returning on January 1, 2007."

"For nearly a decade, the same poisonous policy has haunted the long-term health of America's oldest and frailest seniors," says English. "If Congress does not act this year, seniors will be left to bear the brunt of an unfair financial burden associated with required therapy services. By extending the current exceptions process we will ensure seniors' rehabilitative needs will be met without limiting care to an arbitrary price tag."

"While the exceptions process has not been perfect, once the glitches have been corrected, it can serve as a viable option to provide beneficiaries access to needed services. There are fewer than 60 legislative days remaining this year, and prompt attention to this matter is required. By extending the exceptions process at least through 2007, seniors who have complex conditions will be able to get necessary care. Congress still needs to work with the Administration to develop a long-term alternative to therapy caps," says Cardin.

The rehabilitation coalition includes: American Academy of Physical Medicine and Rehabilitation, American Academy of Neurology, Alzheimer's Association, American Association of Homes & Services for the Aging, American Association on Mental Retardation, American Dance Therapy Association, American Health Care Association, American Heart Association/American Stroke Association, American Medical Directors Association, American Medical Rehabilitation Providers Association, American Music Therapy Association, American Network of Community Options and Resources, American Nurses Association, American Occupational Therapy Association, American Physical Therapy Association, American Speech-Language and Hearing Association, American Therapeutic Recreation Association, Amputee Coalition of America, Arthritis Foundation, Brain Injury Association of America, Catholic Health Association of the United States, Center for Medicare Advocacy, Inc., Christopher Reeve Foundation, Easter Seals, HealthSouth, National Association for the Support of Long Term Care, National Association of Councils on Developmental Disabilities, National Association of Directors of Nursing Administration/LTC, Inc., National Association of Rehabilitation Providers and Agencies, National Association of Social Workers, National Association of State Head Injury Administrators, National Council for Community Behavioral Healthcare, National Disability Rights Network, National Multiple Sclerosis Society, National Rehabilitation Association, National Rural Health Association, National Stroke Association, Parkinson's Action Network, Power Mobility Coalition, The Arc of the United States, United Cerebral Palsy and United Spinal Association.

Text of the letter sent to Senate Majority Leader Frist, Senate Finance Committee Chairman Grassley, Speaker Hastert, House Ways and Means Committee Chairman Thomas and House Energy and Commerce Committee Chairman Barton is provided below.

Dear Congressional Leaders:

On behalf of the undersigned patient, provider and healthcare industry organizations, we write to request your full consideration of the need for passage of legislation in 2006 to address the Medicare outpatient therapy caps. In the 109th Congress, legislation to repeal the caps has gained the support of more than 40 members of the United States Senate and more than 250 members of the United States House of Representatives. If Congress fails to act this year, the arbitrary therapy caps will return on January 1, 2007, and will result in restricted access to rehabilitation services and a shift in patients and costs to inpatient settings.

As you know, these caps were placed on outpatient physical therapy, occupational therapy and speech language pathology services as part of the Balanced Budget Act of 1997. Since this time, Congress has acted three times to place a moratorium on the therapy caps. These caps went back into effect on January 1, 2006. Fortunately, under your leadership, Congress passed legislation as part of the Deficit Reduction Act of 2005 that provided beneficiaries with a clinically based exceptions process to this financial limitation on rehabilitation services under Medicare. The exceptions process appears to be working well to ensure appropriate access to needed rehabilitation services in a fiscally responsible manner.

Since the Deficit Reduction Act authorized the exceptions process only for 2006, we respectfully request an extension of this exceptions process for no less than 2 additional years. This will allow the Centers for Medicare and Medicaid Services to continue to monitor the implementation of this policy and assist in the development of a long-term alternative to the therapy cap. We appreciate your consideration of this request to extend the exceptions process beyond 2006 for a minimum of 2007 and 2008.

Source: American Physical Therapy Association