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  • Government Reopens Under Short-Term Deal That Leaves Medicare Patients in Limbo

    After an approximate 36-hour shutdown, the US government is back in business, which means the push is on to get a permanent repeal of the Medicare therapy cap over the finish line.

    On Monday, January 22, the US House and Senate agreed to fund the federal government through February 8. The deal fully funds the Children's Health Insurance Program (CHIP) for 6 years, and was accompanied by a compromise to bring a vote on the Deferred Action for Childhood Arrivals (DACA) legislation if a deal on immigration is not reached by February 8. What the deal does not include is a repeal of the hard cap on therapy services under Medicare, despite intense lobbying, grassroots, and social media efforts by APTA and members of the Repeal the Therapy Cap Coalition. Also missing from the deal: fixes to a host of Medicare-related critical issues affecting millions of Americans.

    Essentially, the short-term spending bill is intended to buy legislators time to agree on a longer-term funding plan—one that APTA is pushing to include a repeal of the hard Medicare therapy cap now in place. It's an idea supported by several legislators including Sen Ben Cardin (MD), who took to the Senate floor to call for action on the cap by the February 8 deadline.

    For the physical therapy profession, patients, and stakeholders, it's now time to work harder than ever before to make it clear to lawmakers that the hard cap must end.

    Although APTA's efforts to push for passage of a bicameral, bipartisan deal on the therapy cap never let up, the association plans to turn up the heat even more over the next few weeks. APTA is developing a special campaign that will involve physical therapists and patients across the country, and will contact members in the coming days about opportunities for participation. In the meantime, members and supporters are being urged to continue to contact members of Congress via email, phone, and social media, and tell them to pass the therapy cap permanent fix as soon as possible.

    "The time has come for resolution of this unacceptable situation," said Justin Elliott, APTA's vice president of government affairs."A person who is recovering from a stroke or other serious condition may be days away from hitting the hard cap and having Medicare no longer pay for essential physical and speech therapy. Therapy can’t wait—neither can Congress. There is a bipartisan solution to permanently address the hard cap, and Congress must act on it now."


    Visit APTA's Medicare Therapy Cap webpage for more information, download the APTA Action App to keep up-to-date on action alerts, and be sure to stay tuned for additional updates.


    • Repeal the Medicare therapy caps!!

      Posted by Cindy Kowell on 1/23/2018 12:52 PM

    • Our seniors who have worked hard and are the foundation of our country need to have exceptional healthcare. And as aging promotes weakness and more probability of issues there is MORE need for services to be available rather than to be cut. Cuts should be to fraudaulant misuse of Medicaid for those capable of working and who many times are at cash jobs. How disgraceful

      Posted by Cheryl Haque on 1/24/2018 11:14 AM

    • I called AARP to tell all their readers to call their congressmen/senators, but at the time I thought the timer stopped on Jan 18. (Or whatever the exact date was). I think APTA should contact them so they will push all their memebers to call in. Thanks!!!

      Posted by Cindy Neiburg on 1/24/2018 4:31 PM

    • Failure to repeal the Medicare therapy caps could be disastrous for many Medicare recipients. Therapy is a necessity for many to be able to continue living independently and safely. Restricting these services ultimately could become a huge financial burden to the nation.

      Posted by Susan Gray, PT on 1/24/2018 7:29 PM

    • Today CMS came out and wrote an FAQ that therapists should follow our plan of cares and go ahead and submit claims over the cap with a KX modifier... so they can hold the claims and release payment after something is voted on. This is such reverse psychology for them to remove the blame from the government onto us, and we cannot afford to take this burden on given the poor state of reimbursement from all parties. In no way can I pay my therapists to see patients that I may never get paid for. I will not and cannot as a private practice take on this expense and we cannot stand for taking the ethical wrongs off the governments shoulders and onto ours. When will CMS learn that we cannot simply function for free... we have lights, and secretaries and numerous fees to billing agents to navigate the reimbursement world just to get paid. Extremely frustrating!

      Posted by Melanie Brennan on 1/24/2018 10:21 PM

    • Once again Senator Cardin has taken up this cause on the Senate floor. Thank you, Senator, for your unwavering support!

      Posted by Marsha Lawrence on 1/24/2018 11:01 PM

    • I would like to have therapy caps have permanent solutions to allow Medicare patients needed services that the $2010 per year does not cover. Every day I hate having to tell my Medicare patients that they have only $2010/yr for PT and Speech combined. We need a fair solution now at least give PT and Speech separate budgets equal to individual OT budgets. Sarah

      Posted by SarahKacic on 1/24/2018 11:06 PM

    • If a patient does not receive adequate therapy the risk is higher for re-occurrence or re-injury potentially causing more cost to the system. It is time to repeal the caps and give seniors the services they deserve!

      Posted by Kathleen on 1/25/2018 8:54 AM

    • Please stop the cap. My patients often need more than an arbitrary number of visits per year. PT is a cost-effective solution to many Medicare recipients chronic pain and mobility problems.

      Posted by Brad Banker on 1/25/2018 8:54 AM

    • Having experience in the past dealing with Congressional members and Committees, I believe the following would be the most effective lobbying approach: (1) Document several, verifiable examples of "CAP-Breakers" forced to expend their own resources for Therapy, from those States that have tenured members on the relevant Senate and House Committees. (2) Examples selected should not come from the Senior community alone; rather, the impact of CAPs on all categories of Americans should be emphasized to garner the most support. (3) Recognizing the importance of item (2) above, also opens the door to other support groups such as the disabled, Hispanics and Unions who face the need to adequately care for injured workers. .

      Posted by Alan Lafferman on 1/28/2018 12:40 PM

    • PLEASE stop this cap, recovering from stroke, collage degree, worked best 30+ years, paid my dues, 2 brian aseryisms, caused stroke out of blue. This cap would go against my life being saved plus my willingness to partake. Odds were staked against me 96 to 1.

      Posted by Cynthia Clark on 2/2/2018 8:57 PM

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