APTA Applauds Legislation Aimed at Protecting
Medicare Beneficiaries Introduced on the First Day of 111th
ALEXANDRIA, VA, January 7, 2009 — Physical therapy services for
Medicare beneficiaries would no longer be limited by arbitrary financial
caps under legislation introduced Tuesday in the Senate and House of
Representatives, according to the American Physical Therapy Association
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
"Therapy is necessary to effectively manage and confront many
age-related diseases, such as stroke, Parkinson's, and congenital heart
failure," said Ensign. "Every year in the Senate we debate this issue of
therapy caps, and this year needs to be the last."
Becerra added, "Everyday, Americans who suffer from debilitating
diseases like Parkinson's or are recovering from serious injury need
medical therapy in order to reach their highest functional level. It is
outrageous that in addition to focusing on their rehabilitation, they
also have to worry about whether they will exceed Medicare's monetary
caps. These arbitrary caps on physical, occupational and speech therapy
are incompatible with the goal of recovering these patients' ability to
function normally in their everyday lives."
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.
Lincoln said, "Therapy caps can preclude seniors from getting the
care they need to maintain a healthy quality of life. I will continue my
work in the 111th Congress to find a legislative solution so that
patients receive the quality care they need without undue burden. As a
nation, we have a responsibility to protect and support our seniors, and
I remain committed to fighting on their behalf."
"I am concerned that Medicare beneficiaries recovering from a stroke,
hip fracture, or other disease or condition requiring extensive therapy
will not be able to receive all of the services they need under this
cap," said Collins. "Moreover, Medicare patients will have an incentive
to seek services in the hospital outpatients setting, which are not
subject to the cap and are more expensive."
Cardin added, "Rehabilitation therapies are critical to helping so
many Americans recover from injuries and debilitating illnesses. 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. We must take action now to eliminate
APTA President R Scott Ward, PT, PhD, who attended Tuesday's swearing
in ceremonies, said, "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. It's time to end the year-to-year fixes and pass legislation that
fully protects beneficiaries."
"Congress has a responsibility to pass a permanent solution for
therapy caps to ensure our nation's consumers continue to receive
much-needed treatments," said Ross. "I am proud to join with my
colleagues as an original cosponsor of this important legislation to
provide long-term relief to patients and health care providers, and I
will continue to advocate for its passage in the House of
Blunt noted, "Congress has voted time and again to temporarily fix an
unintended consequence of legislation passed more than a decade ago.
It's about time that we pass a permanent fix so people on Medicare can
receive the therapy their doctors recommend without having to worry
about arbitrary payment caps."
Physical therapists are highly-educated, licensed health care
professionals who can help patients reduce pain and improve or restore
mobility - without expensive surgery or the side effects of medications.
APTA represents more than 70,000 physical therapists, physical therapist
assistants, and students of physical therapy nationwide. Its purpose is
to improve the health and quality of life of individuals through the
advancement of physical therapist practice. Learn more about conditions
physical therapists can treat at www.apta.org/consumer, and find a physical therapist
in your area at www.findapt.us.