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  • Welcome Back: Therapy Cap Repeal Is Reintroduced in Congress

    After falling short by the narrowest of margins in 2015, an APTA-supported bill to end the Medicare therapy cap has been reintroduced in both houses of Congress. And now it's time for the physical therapy community to make its voice heard.

    The bill, named the Medicare Access to Rehabilitation Services Act (HR 807, S 253) would repeal the therapy cap once and for all, ending a battle that has taken place almost every year since the adoption of the 1997 Balance Budget Act. Representatives Erik Paulsen (R-MN), Ron Kind (D-WI), Marsha Blackburn (R-TN), and Doris Matsui (D-CA) introduced the legislation in the US House of Representatives. In the Senate, the bill was introduced by Sens Ben Cardin (D-MD), Susan Collins (R-ME), Dean Heller (R-NV), and Bob Casey (D-PA).

    The cap, which imposes a $1,980 therapy limit on physical therapy and speech-language pathology services (as well as a separate $1,980 cap on occupational therapy services) provided to Medicare beneficiaries, has remained a central focus of APTA's public policy advocacy efforts since its introduction. In 2015, support for ending the cap reached its highest level yet, when repeal efforts were backed by 238 cosponsors in the House but came up 2 votes short in the Senate. The vote was part of a legislative package that ended the flawed "sustainable growth rate" policy that regularly required damaging payment cuts, avoided only by nearly annual ad-hoc "doc fix" legislation.

    What remained was the cap, accompanied by an exceptions process that is set to end on December 31, 2017. After that—and barring repeal—the full force of the cap returns, and more than 1 million beneficiaries in need of rehabilitation could experience severe limitations to access.

    "We have always viewed the SGR and therapy cap as linked concepts in the sense that both put significant obstacles in the way of providing the best patient care," said Michael Matlack, APTA's director of congressional affairs. "While we had hoped that both would be ended in 2015, the repeal of SGR has cleared a path for success and set the stage for what is truly the next step in improving the lives of people in need of rehabilitation."

    While repeal of the cap gained wide support in Congress in 2015, there is no guarantee that the bill will achieve the same backing in the current Congress. That's where the physical therapy community plays a crucial role, and APTA is urging its members as well as patients and supporters of physical therapy to make their voices heard.

    That effort is made easier thanks to APTA resources. Members can email their legislators by way of APTA's Legislative Action Center, while nonmembers and patients can use the APTA Patient Action Center. Adding to the convenience, APTA's action app can make advocacy as simple as a few taps on your smartphone.

    "The reintroduction of the therapy cap repeal is exciting news, but it's also our cue to focus our energies on seeing to it that members of Congress understand the need for this change," said APTA Chief Executive Officer Justin Moore, PT, DPT. "We must get involved now by contacting our members of Congress, and we need to stay engaged throughout the legislative process and be ready to act quickly as the bill makes its way through the legislative process. We could be on the edge of an historic moment in the profession, but that moment will only arrive if we speak up."


    • Stop the Therapy Cap!

      Posted by John Arganbright on 2/2/2017 11:48 PM

    • Plain and simple adding a medicare gap in the long run actually adds to healthcare costs..period!

      Posted by Shane Karamian on 2/3/2017 6:38 PM

    • I'm not sure I agree with Shane, above. In my nearly 40 years experience with MC, I've found a propensity of seniors want "year round therapy," but don't really need it. When they've reached the end of their goals, or near the cap, and told, "that's all we can do under MC, you're really a "maintenance" case now and can pay privately, they say, "well, it's not that bad that I want to pay for it." Another quick eg. Snow birds returning to NE from the south with referrals saying "Therapy for the Summer", to continue year round P.T. Like we're some sort of summer camp service! Not sure we should have "no cap" from my experience, and my opinion which I'm entitled to.

      Posted by Larry Greenberg on 2/8/2017 3:19 PM

    • Please provide us with the information we can pass on to our patients so they may in turn put pressure on their respective representatives.

      Posted by John Duffy, PT OCS on 2/8/2017 3:19 PM

    • Stop the cap and give patients the care they deserve.

      Posted by Pat Jackson on 2/8/2017 3:47 PM

    • We are worried about this when so many are at risk for loosing health coverage if the ACA is repealed? So far I have not seen one position statement on this critical issue for so many Americans.

      Posted by Kathleen Clarke on 2/8/2017 4:26 PM

    • That is similar to putting a household cap on groceries on growing teenage boys...? Why do it? Isn't it in the end, simply a shot in the foot?

      Posted by Kirsten Schelbert on 2/8/2017 4:44 PM

    • I do agree that the cap should at least be extended...but what also might help is insuring less waste with PT visits by ensuring that the utmost quality care is being delivered, with emphasis on education and self care when appropriate, there by decreasing the number of visits needed to reach goals. Performing exercises and activities that could be replaced with more functional, dynamic movement patterns and ensuring that every session is a winner would be great way to prove to those in political power that what we do is medically necessary to improve the safety and quality of life for our Medicare population.

      Posted by Kira on 2/8/2017 4:46 PM

    • Something came to me. How would Medicare maintain cost if the cap were no longer in place? Would they Institute Managed Care? That would be even worse

      Posted by Richard Fowler on 2/9/2017 6:27 AM

    • When is the APTA going to actually get something useful to pass in congress? I get plenty of calls from the PAC and have contributed, and every year they just come shy of getting it done. Part of the reason many therapists are not active members is there is rarely any appreciable results for all of the APTA "efforts". If I had these results in the real world I would have been out of business long ago.

      Posted by Brad Nolin on 2/9/2017 7:00 AM

    • The medicare cap needs to be repealed. Patient's who cannot get access to care due to medicare cap result in hospitalization which cost the goverment substantially more money. Also now that patient is no longer a active consumer resulting in loss of tax revenue at state and federal level. Repealing the cap is common sense. Keeping the cap only continues to raise healthcare cost.

      Posted by Gregory K. LeMoine on 2/9/2017 9:47 AM

    • A radical idea: give seniors or other patients incentives to meet goals in reasonable times when they develop no complications, by offering a fresh slate later in a year if needed...how preventive, how foreign the concept. Yes we need to stop discrimination in giving OT a higher cap than SLP or PT, especially when PT often takes a lead to initiate or sustain care episodes. With that said, some cost control is reasonable.

      Posted by Kate Humphrey on 2/9/2017 10:24 AM

    • I would like to see the therapy cap for Medicare patients removed and if not the combination of PT and Speech benefits combined changed. I cannot believe a grammatical error could occur and not be corrected quickly. The impact on our patients is significant, when the speech and PT have to determine which is the most important care for $1980 /year for a stroke patient is shameful. The Congressmen and Senators should be ashamed of themselves rationing Seniors benefits and putting therapist in a position of counseling patients on how to stretch the therapy dollars instead of providing the care the patient needs. If the Congress members would give up their free healthcare benefits and spread the wealth our healthcare dollars would be better spent on those that need It and cannot afford it.

      Posted by Sarah Kacic on 2/9/2017 12:21 PM

    • Chicken or egg?

      Posted by Jennifer Hundt on 2/9/2017 6:25 PM

    • I agree with the comments made by Kira 2/8/2017. Stopping the repeal of the Affordable Care Act is more crucial at this time. If the monies spent on repealing the Affordable Care Act was spent on FIXING IT then the Senate and Congress would have a better undersatnding of the importance of delivering Health Care IN AN INTERDISCIPLINARY MANNER. This would reduce costs, provide better quality of care to the receipients/patients . The importance of Therapy in providing quality patient care would be seen and thus the importance of repealing the THERAPY CAP. THEY WOULD THEN BE IN A POSITION TO AFFORD TO REPEAL THE CAP AS WELL SINCE THEY WOULD HAVE THE CAPITAL TO DO SO..

      Posted by Anne Kenny on 2/13/2017 10:56 AM

    • In reading some of the posted comments, I would like to encourage ALL PTs to have a global approach to what the cap means to those of us who work primarily with outpatient clients s/p neurological trauma/injury/disease. The majority of our patients in the clinics that I manage are patients with brain injury, spinal cord injury and disorders (MS, GBS, tumors, etc), and stroke. These patients are complex, discharged long before they have maximized their functional potential from any inpatient setting, and most of the time require all 3 disciplines (physical therapy, occupational therapy, and speech therapy). It is OUR responsibility as a profession to determine what is medically necessary care and support that plan of care with reliable outcome measures; it should not be based on a random amount of money. Please support repeal of the cap based on the confidence that physical therapists are educated and trained to determine medical necessity for a plan of care and not an a "cap" of money that is irrelevant to the patient's needs.

      Posted by Cheryl West, PT, DPT on 2/28/2017 8:46 AM

    • Cheryl is right on...it is ours/PTs' responsibility to drive a value proposition that is acceptable to our collective "customers": the patient/client, payer, case manager, attorney etc. My late great father was fond of saying; "figures lie and liars figure". Stop gaming the numbers, e.g. billing up to cap for "maintenance" PT. Look in the mirror and ask yourself; "Would this patient be fine without the PT that I am providing?" And please, be prudent with exercise flow sheets that drone on in terms of 3 sets/10 reps with plateaued numbers. Here is Cheryl's sage advice worth repeating: "It is OUR responsibility as a profession to determine what is medically necessary care and support that plan of care with reliable outcome measures; it should not be based on a random amount of money. Please support repeal of the cap based on the confidence that physical therapists are educated and trained to determine medical necessity for a plan of care and not an a "cap" of money that is irrelevant to the patient's needs." Posted by Cheryl West, PT, DPT on 2/28/2017 8:46 AM

      Posted by David W. Clifton, BS, PT on 10/20/2017 1:49 PM

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