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  • Therapy Cap Repeal Amendment Gives Senators an Opportunity to Keep Up the Drumbeat to End a Flawed Policy

    Two US senators are working to keep repeal of the Medicare therapy cap front-of-mind on Capitol Hill. Though the chance of passage is slim this year, sponsors Ben Cardin (D-MD) and Dean Heller (R-NV) hope that an amendment they sponsored will refocus attention on ending the therapy cap, and help to keep the issue well-positioned when the current exceptions process runs out in December 2017.

    The amendment calls for a full repeal of the payment caps for physical therapy treatment under Medicare Part B, which sets limits at $1,960—an amount that also includes speech-language pathology services. In past years (including 2015 and 2016) the cap has been accompanied by an exceptions process that allows payment for physical therapy over the limit. APTA describes the therapy cap as a policy that "discriminates against the most vulnerable Medicare beneficiaries," and the exceptions process as an "arbitrary" system.

    The senators hope to attach the amendment to a popular bill that addresses the opioid epidemic, but the realistic chances of that happening are not good. Cardin and Heller argue that given the role of physical therapy in the management of chronic pain, it's appropriate to include the cap repeal in the opioid bill. However, both senators feel that even if they aren't successful in getting the amendment added, their efforts will help to remind the Senate that it will take up the issue next year, when the current exceptions process runs out on December 31.

    In past years, a debate over the elimination of the therapy cap has been a more-or-less annual event that was part of the fight to end the flawed sustainable growth rate (SGR), a system that routinely required the so-called "doc fix" to the physician fee schedule to avoid severe payment cuts. With the elimination of the SGR in 2015, the 2 issues were separated. Congress came close to a full repeal of the cap, but in the end decided to keep it—and its exceptions process—in place until the end of 2017. Cardin and Heller aim to remind their colleagues that the issue has not disappeared by any means.

    "These arbitrary caps create an unnecessary and burdensome financial barrier to Medicare beneficiaries who rely on essential rehab services such as physical and occupational therapy to live healthy and productive lives," Cardin said in his floor speech (video of Cardin's entire speech available here). As for the appropriateness of the amendment in the opioid bill, Cardin cited a recent Centers for Disease Control and Prevention (CDC) clinical guideline that asserts physical therapy and other nondrug approaches to chronic pain "have been underutilized and, therefore, can serve as a primary strategy to reduce prescription drug medication abuse and improve the lives of individuals with chronic pain."

    Heller described the effect of a therapy cap repeal in plain terms. "If patients had better access to physical therapy, they would not be as dependent on highly addictive pain medication," he said, adding that "seniors would also have a higher quality of life by treating the sources of the pain and rebuilding their strength."

    Repeal of the therapy cap remains 1 of APTA's highest public policy priorities, and APTA President Sharon L. Dunn, PT, DPT, OCS, voiced the association's strong support of the senators' efforts during this session.

    “APTA believes the latest extension of the exceptions process must be the last, and the therapy cap must be repealed and replaced with meaningful reforms that are in the best interest of the patient,” Dunn said. “APTA will continue to shine a spotlight at every opportunity before Congress on how the misguided therapy cap policy negatively impacts the patients we serve.”

    Repeal of the therapy cap will require a strong, unified voice from the physical therapy profession. Find out how you can take action—and if you really want to get involved, don't miss the upcoming APTA Federal Advocacy Forum in Washington DC, April 3-5. Registration deadline is March 18.


    • oh really its great opportunity for us.

      Posted by sultan niga -> CKQ`AO on 3/6/2016 5:24 AM

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