More than a million beneficiaries are at risk of losing access to their outpatient Medicare Part B therapy services now that the current therapy cap of $2,010 has gone into effect. The American Occupational Therapy Association (AOTA) is working to pass legislation that would completely repeal the therapy cap.
The previous patch on the therapy cap expired on December 31, 2017.
“The beneficiaries who need these services represent the most valuable people receiving Medicare, including those who have had a stroke or have conditions such as Parkinson’s disease, multiple sclerosis, or ALS,” says Amy L. Lamb, OTD, OT/L, FAOTA, president of AOTA, in a media release.
“For 20 years we have been asking AOTA members and beneficiaries to advocate for access to therapy services that are proven to produce positive outcomes and enhance quality of life. With bipartisan agreement on a permanent fix, we must let Congress know that two decades is enough and this arbitrary policy must be repealed.”
Since the passage of the Balanced Budget Act in 1997, consumers have been limited in the amount of occupational therapy, physical therapy, and speech-language pathology they could receive under Medicare Part B. During this time, AOTA has worked alongside the American Physical Therapy Association (APTA), the American Speech-Language-Hearing-Association (ASHA), and a broad coalition of consumer and provider organizations to repeal the arbitrary and harmful barrier to care for a wide spectrum of Americans in need of rehabilitation and habilitation services, per the release.
“With many issues still up in the air from 2017, Congress has given no indication of when it will address the cap on Medicare Part B therapy services,” says Christina Metzler, chief of public affairs for AOTA. “There is a commitment by many of our Congressional champions to end the cap once and for all, but many steps must be taken to make this a reality, and the Congressional calendar is crowded.”
In the meantime, AOTA advises therapy professionals to issue a mandatory Medicare notice, called an Advanced Beneficiary Notice of Non-Coverage (ABN), to all Medicare beneficiaries they treat who may go beyond the $2,010 cap. The ABN is issued in situations where Medicare payment is expected to be denied.
For updates about the Therapy Cap visit AOTA and follow #TherapyCantWait and #StopTheCap on Twitter.