The American Physical Therapy Association (APTA), Alexandria, Va, expressed its support for a new bill that would extend the process that allows Medicare beneficiaries to receive medically necessary coverage exceeding the financial cap on therapy services.

The Securing Effective and Necessary Individual Outpatient Rehabilitation Services (SENIORS) Act (S 3912/HR 6132) introduced by Sens John Ensign, R-Nev, Blanche Lincoln, D-Ark, Jim Talent, R-Mo, Susan Collins, R-Me, Orrin Hatch, R-Utah, Roy Blunt, R-Mo, and Frank Pallone, D-NJ, would extend the current Medicare therapy cap exceptions process that is set to expire December 31, 2006. Without action by Congress this year to extend the exceptions process, many seniors and people with disabilities most in need of physical therapist services may face a choice between forgoing treatment or paying 100% out of pocket when their Medicare coverage runs out.

“Comments from APTA members indicate that the current therapy cap exceptions process has maintained access to needed rehabilitation services in a fiscally responsible manner,” says APTA President R. Scott Ward, PT, PhD. “APTA continues to advocate for the best long-term solution to the arbitrary therapy caps, which is full repeal. But in the current situation, Congress must take action immediately to, at a minimum, extend the exceptions process for another year and protect our patients from the arbitrary caps.”

“I have been a long-time supporter of complete repeal of the therapy caps because I believe them to be unfair to our most vulnerable seniors and disabled Americans,” Lincoln says. “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, effective on January 1, 2007.”

There are two caps on rehabilitation coverage, one for physical therapy and speech therapy combined, and a separate cap for occupational therapy. Earlier this year, Congress passed a provision in the Deficit Reduction Act that authorized CMS to implement an exceptions process to allow beneficiaries who need care above the cap to apply for additional medically necessary coverage, but only through 2006. The bill to completely repeal the therapy caps, The Medicare Access to Rehabilitation Services Act of 2005 (S 438/HR 916) has strong bipartisan support in both the House and the Senate with 259 and 44 cosponsors, respectively.

[SOURCE: PR Newswire, September 21, 2006]