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  • SGR Repeal…Without Therapy Cap Repeal? APTA Calls for Urgent Action

    March 25, 2015: This story was expanded from its original March 24 version to include quotes from the APTA president as well as links to a press release and updated information on the APTA website.

    Legislation now introduced in the US House of Representatives that would end the flawed sustainable growth rate (SGR) is missing a permanent repeal of the therapy cap. According to APTA advocacy staff, it's a troubling omission for physical therapists (PTs), and one that has sparked renewed calls for member action from APTA.

    The bill ready for House consideration repeals the SGR, but only includes a 2-year extension of the therapy cap exceptions process. Supporters of therapy cap repeal believe that the best chance of ending the cap exists when it's tied to an SGR repeal bill.

    Although APTA supports SGR repeal and other features of this particular bill, "We don't view a 2-year extension of this policy as a win," said Mandy Frohlich, APTA vice president of government affairs. "It separates the therapy cap repeal from the SGR repeal, which is problematic."

    In an action alert issued on March 24, APTA warned that the exclusion of a permanent therapy cap repeal in the SGR legislation "is a missed opportunity for a long-term solution and puts beneficiaries in a dire situation when this [proposed 2-year] extension expires." Members are being urged to contact their legislators to call for a permanent repeal of the cap to be included with any bill that would repeal the SGR. APTA has posted the latest information on the issue at the association's therapy cap webpage.

    The association also joined the American Occupational Therapy Association and the American Speech-Language-Hearing Association in issuing a news release that calls the separation of a permanent repeal of the SGR from a permanent therapy cap repeal "a risky approach for Medicare beneficiaries." Occupational and speech-language-hearing therapies are also impacted by the therapy cap.

    "If Congress fails to include a permanent solution for the therapy cap in this bill, it will have purposely missed the only significant opportunity in almost 20 years to fix this critical patient issue," said APTA President Paul Rockar Jr, PT, DPT, MS, in the joint news release. "A bipartisan solution has been negotiated. These policies were created together. They should be fixed together."

    In the (likely) event that Congress does not complete its work on this bill before it recesses on March 28, it is unclear how lawmakers will respond to a looming March 31 deadline that would trigger 21% cuts in Medicare payments via the SGR. It is possible that legislators would approve a short-term extension of the current fixes, but no formal proposals have been released.

    Even if the SGR bill is approved by the House in the coming days, the Senate would be pressed to take it up before Congress recesses. The break, coupled with some Democrats' concerns about other provisions in the legislation, could open a window that would allow grassroots and lobbying efforts to have a greater impact.

    Though the current SGR legislation lacks the crucial therapy cap element, it does include some provisions that are generally supported by APTA. Among them:

    • Positive changes to the competitive acquisition program for Medicare durable medical equipment, prosthetics, orthotics, and supplies
    • The inclusion of the Protecting Integrity in Medicare Act, which bolster's Medicare's ability to fight fraud

    However, the lack of a permanent repeal of the therapy cap represents a glaring flaw in the legislation, according to Frohlich.

    "It's more important than ever for members to speak up on this issue," said Frohlich. "We will continue to work with Senate champions to slow this down to correct this policy."

    The legislative landscape around the SGR and therapy cap continues to change. APTA will monitor the situation and update members as events warrant; however, the need for grassroots efforts on the therapy cap remains urgent. Find out how you can take action.

    Comments

    • Yes and where is the promoting integrity in Medicare ACT HR2914. Funny how we always get left off.

      Posted by dano napoli on 3/25/2015 10:50 AM

    • I have made calls and written letters to my legislators. This was made easy because my connection was made available through the AMA. In their email, they have an 800 number that directs the caller to their specific legislators' offices to relay the need for affirmative action on SGR and therapy caps. You might wish to investigate this and offer the convenience of response to therapists; thereby, securing more supportive action.

      Posted by Edie Watson on 3/25/2015 5:31 PM

    • Please remove the cap entirely - this is affecting real people who need help and an ongoing extension is not the answer. If people need physical therapy to get well, they should be allowed to receive it. Studies show that over the long run, physical therapy saves money by empowering the patient to get better with self care.

      Posted by donna welch on 3/25/2015 10:01 PM

    • I will always fight to protect our clients. Thank for you letting us speak to our representatives.

      Posted by Eileen Carter -> >IQaD on 3/29/2015 11:13 PM

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