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  • Lawmakers Urged to Seize Opportunity to End Therapy Cap

    The Therapy Cap Coalition recently sent a letter to House and Senate leadership urging legislators to add permanent repeal of the therapy cap to the current sustainable growth rate (SGR) reform proposal.

    Sent to House Ways and Means Committee, House Energy and Commerce Committee, Senate Finance Committee, and House and Senate leadership, the February 14 letter from the coalition describes the group's disappointment that the SGR compromise reached in early February did not contain other legislative provisions, specifically language repealing the therapy cap, and suggests that existing proposals could be included in a final package. Specifically, the coalition recommends language in the original Senate version of the bill, which contained a repeal of the cap and replacement policies for the delivery of outpatient therapy.

    The letter emphasizes that lawmakers need to act soon. "The first quarter of 2014 provides an opportunity to end the pattern of yearly extensions that puts patient access to medically necessary therapy services at risk," the letter states.

    The Therapy Cap Coalition, led by APTA, is a group of health care stakeholders that includes patient, consumer, provider, and facility organizations such as the American Heart Association, the American Occupational Therapy Association, the American Speech-Language Hearing Association, the Arthritis Foundation, the National Stroke Association, and the Brain Injury Association.

    APTA's advocacy team is now encouraging grassroots efforts to members and supporters to urge their legislators to include a repeal of the therapy cap in the final bill. Find out how you can take action.


    • And legislators & insurance companies selling supplemental policies need to understand that these policies sold to Medicare beneficiaries make no sense when the copay amount for a therapy outpatient visit is $30, $40 or even $50 per visit. These beneficiaries are on a fixed income and cannot afford such outlandish copay amounts!

      Posted by James K. Haberstro, PT on 2/22/2014 4:14 PM

    • I agree with James. In fact, we have had times when the copay exceeded the Medicare allowable charge for the service!

      Posted by Mary Ann Webb on 2/24/2014 8:28 AM

    • I have several patients that are paying $70 copay per visit. This is truly beyond retirees capabilities to pay and serves only to limit the care that they need.

      Posted by Alicia Nixon on 2/26/2014 9:29 PM

    • The Medicare therapy cap doesn't apply to Medicare Advantage programs. When Medicare patients are paying high co-payments in the range of $30-50 that is their Medicare Advantage plan, not their supplemental plan. The supplemental usually pays 20% of the Medicare allowed amount. Patient out-of-pocket that exceed the allowed amount seems improbable. Patients have elected their Medicare Advantage plan instead of Traditional Medicare usually because the privately run Medicare Advantage program does not charge the patient the monthly Medicare Part B premium. The patient is buying down the insurance on the front end (premiums) but paying more on the back end (co-payments) when they access physical therapy. The fact that private Medicare Advantage offers a better, less expensive option for consumers than the more costly Traditional Medicare just proves the current system is broken. By the way, recent peer-reviewed suggests that Medicare Advantage, in addition to lowering costs, is beginning to improve health outcomes for its clients/customers. Tim Richardson, PT www.PhysicalTherapyDiagnosis.com

      Posted by Tim on 3/5/2014 5:59 PM

    • Nicely summarized Tim. I live in a county in Central Florida that has a large number of Medicare beneficiaries who have opted out of the traditional 80:20 split with these Medicare Advantage plans. I disagree with the peer reviewed (articles), however, as I tend to find that lower income beneficiaries overall health is more compromised as they do not access features of these programs like Silver Sneakers, due to socioeconomic reasons. Their seems to be a correlation between these patient’s ability to understand their Medicare benefits and ability to make an educated, cost conscious decision on whether to pay on the front or back end for their uncovered Part B secondary or Medicare Advantage plans. The disparity seems to be caused by the likelihood that they will access less care than their Medicare Part B secondary insured peers, due to the high co pays of a Medicare Advantage Plan. Co payments are required prior to care, while balances on the Medicare gap are frequently billed after the provision of care. I frequently am told stories of representatives hosting a breakfast to ‘sell’ traditional Medicare recipients these advantage products, without the proper contrast and education regarding the trade off between paying a regular premium for part B and paying prohibitive copayments for future care. When I provide this education, I generally find my patient's share a sense of feeling exploited by the sales representatives and as a result, I then receive the request for what option is best for these beneficiaries. I make education regarding all my patient’s health plan coverage an integral part of my patient's care as paying for healthcare in the US continues to be a privilege and not a right.

      Posted by Joe Koloc on 3/22/2014 8:54 AM

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