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  • Therapy Cap Repeal Legislation Introduced in House and Senate

    Today, members of Congress reintroduced identical bills in the House and Senate that would permanently repeal the cap on outpatient physical therapy services. Sens Ben Cardin (D-MD) and Susan Collins (R-ME) introduced the Senate's measure. The House legislation is sponsored by Reps Jim Gerlach (R-PA) and Xavier Becerra (D-CA). 

    With discussion on permanent reform of the sustainable growth rate (SGR) ramping up, Congress also must address long-term repeal of the therapy cap, an arbitrary limit on services that often are medically necessary for patients. Both flawed policies were created in 1997 as part of the Balanced Budget Act and should be repealed this year. Given the opportunity to act on both SGR and the therapy cap, this should be the last time cap repeal legislation should need to be introduced, says APTA.  

    Access to physical therapist services has long enjoyed broad bipartisan support, with approximately 200 members of Congress supporting therapy cap repeal legislation every congressional session.

    If Congress does not act on legislation by December 31, the 2-tier exceptions process that was extended through 2013 by the American Taxpayer Relief Act of 2012 (HR 8), will expire.

    Read comments from the bills' sponsors in APTA's press release


    • I strongly support repeal of the therapy cap. I will graduate as a DPT in 2015 and think that the cap arbitrarely limits care and the provision of needed services.

      Posted by Emma stayduhar on 2/15/2013 4:34 PM

    • It is obtuse to believe a singular Dollar figure can adequately provide any form of health to all individuals annually. Every person does heal at the same rate and each year may impose different health challenges for each person. Payment for physical therapy services should be based on documented skill treatment provided by the clincian and measurable process made by the patient. Anthony miller home health therapy manager. 10 years.

      Posted by Anthony P Miller on 2/16/2013 6:02 AM

    • All of us should strongly support repeal of this arbitrary cap.All of us address VIPs(Very Individual Patients),with their unique individual set of impairments.It's totally absurd that a non-professional should ration the services for needy patients wihout keeping medical necessity,functional limitations and treatment outcomes into cosideration. Vinish,MHS,PT

      Posted by vinish manchanda on 2/16/2013 12:33 PM

    • All insurance plans have their own version of a cap. The two tiered cap for Medicare holds therapists accountable for establishing realistic functional goals, to be accomplished in a reasonable time frame, factoring in all variables, including age, healing rates, comordities etc. At this point clinicians need to realize the US government health care budget is not going to give their clients more coverage. Therefore we should support/fight to uphold the provisions that are currently in place, such as the two tiered cap. The issue clinicians and the APTA should focus it's efforts on is the flawed fee for service billing model and flawed medicare calculation that annually reduces the amount clinicians are paid for services delivered.

      Posted by Paul Fitzgerald -> >ITaEH on 2/18/2013 12:54 PM

    • response to Mr. Fitzgerald's comments: true, all insurances set limits. However there are at least 2 flaws in the current legislation. The first is a clerical error (omission of a coma between physical therapy and speech thereapy) that has led to a COMBINED cap for 2 different services. The second problem is setting a PER year cap rather than a per encounter guideline. Why should a patient who had total knee surgery in January be restricted in the number of visits he needs in Sepetember when he hurt his back or neck (or had a stroke, etc.)?

      Posted by Joyce Adams, MSPT on 2/19/2013 12:28 PM

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