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  • Inaction by Congress Triggers No-Exceptions Therapy Cap in 2018

    In a development that leaves patients and providers in the lurch, Congress has recessed without addressing the Medicare therapy cap in any meaningful way. The inaction is particularly disappointing for APTA and other stakeholders given that a bipartisan agreement had been reached to permanently end the hard cap.

    The bottom line: beginning on January 1, 2018, the $2,010 hard cap on physical therapy and speech-language pathology services combined will be instituted, and the exceptions process that currently permits medically necessary services above the cap through use of the KX modifier will no longer apply.

    In late October, Congress seemed poised to enact a permanent repeal of the hard cap and included that change in a package of Medicare "extenders." Had those extenders been approved, it would have ended Congress' continual tradition of late-year scrambling to come up with a short-term exceptions process. Instead, Congress recessed without approving the extenders or enacting a temporary exceptions process.

    Over the past several months, thousands of APTA members called and tweeted their members of Congress, and generated over 20,790 emails to Capitol Hill urging Congress to pass the permanent fix for the therapy cap

    "Congress’ inaction creates the worst-case scenario for patients and providers," said APTA President Sharon Dunn, PT, PhD. "Medicare patients will start the new year unsure if they will receive medically necessary care. This inaction by Congress means arbitrary barriers, stress for patients and their families, and disruptions for providers."

    The therapy cap is just 1 of several issues left unresolved by Congress. A number of other critical Medicare extender policies that needed action, but also will now expire on December 31, include everything from special payments for ground ambulances, to reauthorization of special needs plans, to an extension of the State Health Insurance Health Programs.

    There is a chance the cap could be short-lived. Congress returns from its recess on January 19, and APTA’s congressional advocates and other patient and provider groups that are part of the Repeal the Therapy Cap Coalition will work to get the bipartisan agreement included in the next "must-do" bill to be taken up.

    "Congress is well aware of the negative ramifications of the therapy cap, which is why there is bipartisan support to repeal it," said Justin Elliott, APTA's vice president of government affairs. "It is imperative that Congress take action as soon as possible in January, and we will keep up the fight."

    APTA also will provide additional information and resources to help practitioners prepare for the application of the hard cap on January 1.

    Comments

    • I guess Senators and Congresspeople were not thinking of their aging relatives when they allowed this deadline to pass. Seniors often need PT after falls, surgery, onset of osteoarthritis and as a less risky alternative to more expensive surgery. So Medicare will pay for surgery but not PT as an alternative to surgery? How ridiculous!!!!!

      Posted by Elaine Pollack on 12/23/2017 7:28 AM

    • As someone who works post rehab and medical exercise, it becomes much more likely that we will have to increase client load and reduce costs in order to continue treating long term or chronic injuries and reduce time spent on individual care.

      Posted by Justin Walls on 12/23/2017 9:17 PM

    • Repeal the CAP restrictions on PT and speech therapy care. Too many patients will suffer unless this is taken care of immediately

      Posted by Marcia Roses Schachter on 12/24/2017 10:15 AM

    • Entitlement reform through professional apathy of the Congress.

      Posted by Jared Kipnis on 12/26/2017 12:34 PM

    • Once again they have left our patients' care hanging in the balance while they recess. In the past 18 years I have seen this happen over and over and over....I had such hopes that this year would the the time they FINALLY handled this ridiculous cap before heading off to celebrate the holidays. No such luck.....just very disappointing to say the least!

      Posted by Heather Hatcher -> >JS^<G on 12/26/2017 4:17 PM

    • Despite the current hard cap for Medicare in 2018. I believe the hard work done by the APTA will come through by the end of January 2018. We have this time as it takes 15-20 sessions to reach the cap. I am positive this will work its way out and am thankful for the work of my association.

      Posted by Joseph Grabicki on 12/26/2017 6:11 PM

    • C’mon you guys! People are depending on you! This is a direct service to the public. You have to be sensitive to those issues.

      Posted by Brenda Nelson on 12/26/2017 11:44 PM

    • Being a physical therapy in South Florida- I cannot begin to tell you the implications this will have on my patients. We must keep pressing our Congress to repeal the cap once and for all.

      Posted by Miri Ingwer on 12/27/2017 3:14 PM

    • They don't understand how this going to affected ALL the patients. We must keep touching this matter to our Congress to repeal the cap.

      Posted by asaad saeed -> DFV]CL on 12/28/2017 1:33 PM

    • Does the JIMMO ruling change? Can patients continue if skilled care is still required to prevent regression?

      Posted by John Hendrickson on 12/29/2017 10:24 AM

    • I think separating out ST and PT combined would help, especially for strokes taking both.

      Posted by Kelly Bogowith -> @ITbCM on 12/29/2017 11:33 AM

    • Asa therapist working in LTC SNF x 15 years I have witnessed so much medically unnecessary care promoted for corporate profit. I have refused to Pick people up for therapy that were passed on to someone else. This is why Medicare is pushing back Millions of dollars n fraud. See the recent lawsuits and therapy whistleblower We need to help empower therapists to deal w this pressure. I had a friend fired due to low case load n an ALF setting. She said n 40 beds she was to Have a full case load and see patients 90 Days no matter what. This is the real Issue of caps. If you can justify complexity of patient condition and need for skilled services there is cap exception.

      Posted by Jennifer on 12/29/2017 2:38 PM

    • This is an embarrrassment to the APTA and Congress. The lack of respect our insurers and elected officials have towards our profession is disheartening after 37 years in the profession.

      Posted by Dorothy Foigelman-Holland -> BFRa on 12/29/2017 9:07 PM

    • Why do we depend on what congress does at all??? Too much regulation and rationing of care. We can’t even offer cash pay to these patients at my hospital system because of the deal we have with the government payers. Instead of wasting money lobbying for higher caps APTA should just say gov should stay out of deciding what’s best between patients and PT.

      Posted by Norm on 12/30/2017 9:03 PM

    • I was a geriatric nurse for 40 years. What you are doing with a cap is unacceptable. Through my career I always wondered why the government did not ask the people who care for and about their people. Politicians should learn to research and listen when it comes to healthcare that they know nothing about! I hope you are all listening now!

      Posted by Deb Hatlestad on 1/3/2018 9:49 PM

    • What is wrong with you thoughtless people!? Putting a cap on much needed therapy is just wrong! You need to fix this. Do the right thing!

      Posted by Kelly P Webb on 1/4/2018 11:41 AM

    • OMG! What are you people doing? This lowest of the low caps will keep patients from seeking treatment, and will force caregivers to do much less than prescribed. Are you trying to kill us all??? I think you are all penny-pinching toads!

      Posted by Francine Sutton on 1/6/2018 10:06 AM

    • This seems shortsighted. A senior with (ie) hip/knee replacement needs good PT to regain mobility. Less mobility means more fractures, increased home/nursing home care, more cost overall. PT is a low cost solution to a myriad of collateral issues.

      Posted by Joan M Gould on 1/8/2018 7:42 PM

    • I fall into this category. I was told yesterday that my pt sessions will end immediately. I have thinning discs in my lower back resulting much pain over the Last thirty plus years. Im trying to avoid back surgery. Now this !!! I hope this is resolved soon. I'm very hurt and dissopointed over the news I received on Jan.22, 2018

      Posted by James Lewis on 1/24/2018 12:33 PM

    • Keep contacting Congress and any other local lawmaker to make sure they understand how important this issue is to you. If you don't then they're not going to change anything, or at best not hurry up to fix what you want fixed.

      Posted by Bob Bobsen on 1/29/2018 11:02 AM

    • Why should there be any caps if the treatment is medically necessary, and there are safeguards for abuse. Also patients who need durable equipment like compression garments should be able to have them covered. We paid into Medicare for decades-why ration health care now?

      Posted by Charles A Bennett on 1/30/2018 12:59 PM

    • I just started making good physical therapy progress, and now I have to stop due to this cap. We aren't even using all the possible sessions just in case some emergency happens in the future and I need PT. My physical therapist and my doctor would prefer me being able to continue. Repeal the cap! You would not be happy if you were told you need more PT but cannot get help.

      Posted by Ronda Matlow on 2/1/2018 1:26 PM

    • There should be NO caps at all regulated by Medicare because they abuse their power to save $. It is not determined by Medical Necessity. I could give you example after example of their decisions directly causing further harm to patients who try to do their HEPs at home and suffer further injuries from falls. And you, as a medical professional, have no recourse. What good does it do to appeal the decision of the people who want to keep the $ ? And whoever decided that stroke patients have to make a choice in whether to talk or walk again? Is that what people paid for all their working years?

      Posted by Joy Taker on 2/1/2018 4:59 PM

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