APTA and Coalition Partners Push for Extension of Medicare Therapy Cap

In a letter to Congress, more than 40 organizations representing patients, health care providers, and advocates joined the American Physical Therapy Association (APTA) in urging members of Congress to extend the Medicare therapy cap exception process beyond 2006.

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," said 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." He added, "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," said Senator John Ensign (R-NV).

"The therapy cap is unfair to our most vulnerable seniors and disabled Americans," Senator Blanche Lincoln (D-AR) said. "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," said Rep. Phil English (R-PA). "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," said Rep. Benjamin L. Cardin (D-MD).