Law Would Dismantle Therapy Cap for PT Services for Medicare Beneficiaries

Legislation introduced on April 15 will protect seniors from arbitrary limits on physical therapy services often needed following a stroke, traumatic brain injury, or hip fracture, or to manage conditions such as Parkinson disease, multiple sclerosis, or arthritis, according to the American Physical Therapy Association (APTA), Alexandria, Va.

The Medicare Access to Rehabilitation Services Act (HR 1546 /S 829) introduced in the House of Representatives by Reps Jim Gerlach (R-Pa) and Xavier Becerra (D-Calif), and in the Senate by Senators Ben Cardin (D-Md) and Susan Collins (R-Me) would permanently repeal the $1,870 therapy "cap" imposed on physical therapy and physical therapy and speech-language pathology services for all outpatient settings, with the exception of hospital outpatient departments. A separate cap applies to occupational therapy.

"The detrimental effects of the therapy caps on patients are well-documented," said APTA President R. Scott Ward, PT, PhD. "When patients approach the cap, they often begin rationing their care to avoid exhausting their benefits. When they exceed it, they are forced to bear 100% of the cost of care. At this point many patients have no choice but to forgo services. Beneficiaries who fail to receive the physical therapy services they need in a timely manner often require higher-cost interventions down the road to remain functional. The cap is simply a bad policy that must be completely reversed."

The therapy caps were created in the 1997 Balanced Budget Act to save resources needed to balance the federal budget. Congress has recognized the therapy cap’s potential harm to Medicare beneficiaries by passing moratoriums on its enforcement several times. In 2006, Congress allowed the therapy caps to go into effect but authorized Medicare to allow exceptions for beneficiaries needing additional rehabilitation services based on diagnosis, clinician evaluation, and judgment. Congress has acted annually to extend these exceptions for beneficiaries, but the exceptions are only authorized through December 31.

[Source: APTA]