Finance Committee Chairman Urges Delay in
Enforcement of Caps
ALEXANDRIA, VA, July 3, 2008 — The American Physical Therapy
Association (APTA) applauds Senator Max Baucus (D-MT) for urging the
Centers for Medicare and Medicaid Services (CMS) to maintain the
exceptions process to Medicare Part B therapy caps in a letter sent yesterday to Health and Human Services
(HHS) Secretary Michael Leavitt.
"Physical therapists thank Senator Baucus for his strong leadership
in fighting an arbitrary financial limit on therapy services that do not
account for the patients' clinical needs," said APTA President R Scott
Ward, PT, PhD. "This arbitrary limit would have the greatest impact on
those patients who need the care the most to recover and rehabilitate
from injuries, impairments, and disabilities." Ward added, "Congress has
long recognized that the therapy caps are bad policy. In the past,
moratoriums have been passed or an exceptions process could be utilized
by those patients requiring additional services. In failing to pass
legislation to assure that beneficiaries continue to get the therapy
care they need, Congress has placed the health of many seniors and
persons with disabilities in jeopardy."
In a letter to HHS Secretary Michael Leavitt, Senator Baucus urged
the delay of the enforcement of the caps, stating: "I write today
to...allow the exception process to remain in place until Congress acts
to extend the moratorium and reinstate the exception process.
Alternatively, I ask that you delay processing claims for therapy
services provided to beneficiaries subject to the cap. With strong
bipartisan support, Congress has consistently acted to prevent therapy
caps from going into effect and is on the verge of doing so again."
Baucus also requested that the exception process be extended for seniors
who require therapy services beyond the limits, stating "H.R.
6331...contains an 18-month extension of the exception process. I
respectfully request that the Centers for Medicare and Medicaid Services
maintain the exception process to the therapy caps or delay processing
relevant claims until Congress has the opportunity to act following the
Independence Day recess."
Outpatient physical therapy, occupational therapy, and
speech-language pathology services provided in practice settings other
than hospital outpatient departments are now subject to a financial
limit, or "cap" of $1,810 as of July 1, 2008. There are no longer
moratoriums on the cap or an exceptions process in place to be used by
patients who require these services.
More than 700,000 Medicare beneficiaries will exceed their limit on
Part B outpatient therapies this year because therapy services provided
during the first six months of this year are included in the cap even
though the services were provided under the earlier exception. This will
force patients to pay out of pocket for therapy services or even to
postpone or neglect getting the treatment they need.
Ward concluded, "We join Sen Baucus in working on behalf of Medicare
patients. We will explore all viable options for keeping these policies
from harming patients, and we urge Congress to come to a speedy
resolution when it reconvenes in July and pass legislation that remedies
this critical situation."
APTA (www.apta.org) is a national organization representing physical
therapists, physical therapist assistants, and students nationwide. Its
goal is to foster advancements in physical therapist education,
practice, and research. Consumers can visit www.findapt.us to find
a physical therapist in their area, as well as www.apta.org/consumer for physical therapy news and