Bill Promoting Patient Access to Therapy Introduced Today

Legislation to Repeal Therapy Cap Would Ensure Availability of Medically Necessary Therapy Services. 

Alexandria, VA, February 14, 2013 — Legislation to be reintroduced today will protect patients from arbitrary limits on physical therapy services so often needed after a stroke, traumatic brain injury, or hip fracture, or to effectively manage conditions such as Parkinson disease, multiple sclerosis, or arthritis, says the American Physical Therapy Association (APTA). APTA has long supported and fought for a repeal of the controversial therapy cap.

The Medicare Access to Rehabilitation Services Act introduced in the US House of Representatives by Reps Jim Gerlach (R-PA) and Xavier Becerra (D-CA), and in the US Senate by Sens Ben Cardin (D-MD) and Susan Collins (R-ME) would permanently repeal the $1,900 therapy "cap" imposed on physical therapy, occupational therapy, and speech-language pathology services. APTA applauds these members for reintroducing this vital legislation.

"An arbitrary therapy cap on outpatient services without regard to clinical appropriateness of care discriminates against the most vulnerable of Medicare beneficiaries," said Gerlach. "In addition, these caps shift costs, delay care, and reduce an individual’s ability to remain independent in his or her home and community. So I look forward to working with my colleagues on enacting this common sense legislation to ensure seniors continue to have access to the care they need and deserve."

Created as a part of the Balanced Budget Act of 1997, the therapy cap places an annual financial limit on payment for outpatient therapy services under Medicare Part B. Physical therapy and speech language pathology services are under a combined cap, and another cap is applied to occupational therapy. Created out of a need to balance the federal budget, the cap policy was not based on data and was applied without consideration for quality of care or clinical judgment. Since its passage, Congress has attempted—multiple times—to forestall the negative consequences of cap implementation, first through moratoriums and now through an exceptions process.

With discussion of reform of the sustainable growth rate (SGR) ramping up, APTA is calling on Congress to also address permanent repeal of the therapy cap. Given the opportunity to act on both the SGR and the therapy cap, APTA believes this should be the last time this important legislation should have to be introduced and that it should be passed this year. Until the cap is fully repealed, patient access to medically necessary rehabilitation services will continue to be threatened.

"Rehabilitation therapies are critical to helping millions of Americans recover from injuries and debilitating illnesses," said Cardin. "We should be helping seniors get the therapy they need so they can resume their normal lives, not putting up road blocks to their recoveries. Year after year, Congress has shown its disapproval for these arbitrary therapy caps with short term fixes. Now, with this legislation, we have an opportunity to eliminate them permanently."

The legislation has historically enjoyed broad bipartisan support in Congress with approximately 200 members cosponsoring the bill each session. APTA is also committed to continuing to work with the committees of jurisdiction, CMS, and MedPAC, to implement long-term payment reform policies, with repeal of the therapy caps and appropriate patient access to services remaining the ultimate goal.

Physical therapists provide evidence-based services to decrease disability, improve function and independence, prevent illness, promote wellness, and restore quality of life to the patients/clients they serve. Physical therapist services lower the rate of disability and associated clinical cost by reducing the need for services of greater expense and/or greater risk to the patient/client.1 

About APTA
The American Physical Therapy Association (APTA) represents more than 85,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area at Consumers are encouraged to follow us on Twitter (@MoveForwardPT), Facebook, YouTube and Pinterest.

1Peterson LE, Goodman C, Karnes EK, Chen CJ, Schwartz JA. Assessment of the quality of cost analysis literature in physical therapy. Phys Ther. 2009;89(8):733-755.

CSM 2016