Physical therapy services for Medicare beneficiaries would no longer be bound by arbitrary financial caps under legislation introduced this week in the Senate and House of Representatives, according to the American Physical Therapy Association (APTA).
The Medicare Access to Rehabilitation Services Act (S 46/HR 43) introduced by Senators John Ensign (R-NV), Blanche Lincoln (D-AR), Susan Collins (R-ME), and Ben Cardin (D-MD), and Representatives Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO) calls for the repeal of the Medicare therapy caps that limit coverage of outpatient rehabilitation services to $1,840 for physical therapy and speech language pathology combined, and $1,840 for occupational therapy services.
The therapy caps were originally adopted by Congress in the Balanced Budget Act of 1997. The caps reduce beneficiaries’ access to critical services by limiting their choice of providers by requiring them to pay 100% of the cost of care once they exceed the cap or ration their care to avoid exhausting their benefits. Since 1997, Congress has acted to prevent implementation of the caps by passing several moratoria and authorizing an exceptions process for rehabilitation services above the financial limitation, based on diagnosis and clinician evaluation and judgment.
An 18-month extension of the exceptions process was included in the Medicare Improvements for Patients and Providers Act (HR 6331), which passed July 15, 2008. The exceptions process is set to expire December 31, 2009.
"By introducing this legislation on the first day of the 111th Congress, our nation’s leaders are sending a clear message that total repeal of the caps is the best long-term solution to ensuring that Medicare beneficiaries receive the rehabilitation services they need," says APTA President R Scott Ward, PT, PhD, who attended Tuesday’s swearing in ceremonies." It’s time to end the year-to-year fixes and pass legislation that fully protects beneficiaries."