Legislation to Repeal Therapy Caps Introduced by House and Senate

January 14, 2009 · Posted in Reimbursement 

According to the American Physical Therapy Association (APTA), physical therapy services for Medicare beneficiaries would no longer be limited by arbitrary financial caps under legislation introduced this month in the Senate and House of Representatives.

The Medicare Access to Rehabilitation Services Act (S 46/HR 43) introduced calls for the repeal of the Medicare therapy caps that limit coveraege of outpatient rehabilitation services to $1840 for physical therapy and speech language pathology combined and $1840 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.

The repeal of the therapy caps protects Medicare beneficiaries, ensuring they receive the rehabilitation services they need as they recover from serious injury or suffer from debilitating diseases.


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