Caps Effective January 1; APTA Disappointed With Congress's Inaction

APTA disappointed by Congress's failure to pass legislation ensuring care for seniors

ALEXANDRIA, VA, December 27, 2009—Medicare beneficiaries recovering from stroke, hip fracture, or other conditions that require extensive therapy will soon be faced with arbitrary financial limits on their rehabilitative services, as Congress has failed to extend an exceptions process for services above the financial "cap" based on diagnosis, clinician evaluation, and judgment, says the American Physical Therapy Association (APTA).

The lack of action by Congress is troubling, especially as it had the opportunity to attach a temporary extension to the caps exceptions process to the Department of Defense Authorization Act as it did with physician and provider payments, including those to physical therapists. APTA is discouraged and disappointed that Congress is allowing an arbitrary annual cap on outpatient rehabilitation services to be placed on Medicare beneficiaries on January 1, 2010. This is clearly inconsistent with efforts by President Obama's administration and the Democratic majority to reform health care by eliminating arbitrary limits imposed by private insurance companies. Congress must hold the Medicare program to the same standard. Ensuring payments to providers, including physical therapists, while allowing this cut to rehabilitation services for seniors and people with disabilities during the health care reform debate is gravely disconcerting.

The Medicare therapy caps were originally adopted by Congress in the Balanced Budget Act of 1997. Since 1999, Congress has acted to prevent implementation of the caps by passing several moratoria and authorizing the exceptions process. 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.

"We're disappointed that Congress has not taken action to extend the caps exceptions process and ensure that America's seniors will received the full spectrum of rehabilitative services needed to recover from a fall or stroke or to manage Parkinson's or other chronic diseases and conditions," said APTA President R. Scott Ward, PT, PhD. "APTA supports permanent and full repeal of financial caps. However, until such time, the exceptions process must remain intact."

The Patient Protection and Affordable Care Act (HR 3590) and the American's Affordable Health Choices Act (HR 3962), the US Senate's and the US House of Representatives' health care reform proposals, both contain provisions to extend the caps exceptions process. However, as it is unlikely that reform will pass by December 31, a temporary extension of the exceptions process would guarantee that Medicare beneficiaries would receive uninterrupted rehabilitative care until comprehensive reform legislation is passed.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility — in many cases without expensive surgery or the side effects of prescription medications. APTA represents approximately 76,000 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, education, and research. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at