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  • APTA CEO Moore Testifies to Congress on Repeal of the Therapy Cap

    APTA Chief Executive Officer Justin Moore, PT, DPT, was offered an opportunity to testify on repeal of the Medicare therapy cap before a House of Representatives subcommittee on July 20. He cut right to chase.

    Calling the Medicare Part B cap on therapy services "an arbitrary barrier for Americans who are in need of rehabilitation services," Moore made the case to the House Energy and Commerce Committee's health subcommittee that now is the time to do away with the yearly ritual of quick-fix exceptions to the $1,980 combined limit on physical therapy and speech language pathology services and the $1,980 limit on occupational therapy.

    According to Moore, the fundamental problem is the same as it's been since the cap was implemented in 1997: if actually adhered to without exceptions, the payment limits would be detrimental to patients in need of rehabilitation, particularly among the most vulnerable. And the traditional workaround—instituting an exceptions process—is disruptive.

    "This pattern of yearly extensions without a permanent solution creates uncertainty for beneficiaries and providers, threatens access to care, and is not in the best interest of patients, providers, or the Medicare program," Moore told legislators.

    Moore pointed out that with 177 cosponsors, the bill to repeal the therapy cap now in the House (HR 807) has strong bipartisan support, and said that while there are costs associated with a repeal, those costs only will go up the longer Congress doesn't act. Moore also reminded legislators that the scramble to create exceptions processes has a price tag of its own. "With the money spent on these temporary patches over the past 2 decades, we could have easily paid for a permanent solution," he said.

    The effort to end the therapy cap marks the 17th attempt to move away from what originally was intended to be a temporary provision adopted as part of the 1997 Balanced Budget Act. Support for ending the cap reached its highest level yet in 2015, when repeal efforts were backed by 238 cosponsors in the House but came up 2 votes short in the Senate. The vote was for an amendment to legislative package that ended the flawed "sustainable growth rate" policy regularly requiring damaging payment cuts, avoided only by nearly annual ad-hoc "doc fix" legislation.

    In his testimony, Moore suggested that changes proposed in 2015 set the stage for viable review programs that would ensure appropriate spending without resorting to caps. The cap could be replaced with a "thoughtful medical review that is more targeted, ensures that care is delivered to more vulnerable patients, streamlines the ability to deliver that care, and ensures the long-term viability of the Medicare program," Moore said. He added that the current $3,700 review threshold is providing "appropriate oversight, and could be improved and incorporated into a permanent solution."

    Moore spoke on behalf of APTA, the American Speech-Language Hearing Association, and the American Occupational Therapy Association, which have worked together for years to end the therapy cap. He told lawmakers that the coalition advocates that any therapy cap repeal plan be based on 3 basic principles: ensuring patient access without unnecessary delays, establishing a targeted oversight systems that do not result in interruptions in care, and creating better alignment with value and performance-based models of care.

    "The therapy community stands ready to work with this committee to finally, after 20 years of extensions and moratoriums, repeal the therapy cap and find a permanent fix," Moore said.

    In an APTA video dispatch after his testimony, Moore described the targeted medical review process enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as a "positive result" that should give Congress and the Centers for Medicare and Medicaid Services confidence that there are more effective ways to monitor costs. Those confidence-building MACRA results, along with the strong grassroots advocacy efforts of APTA members and enthusiasm in Congress, may be combining to make the end of the therapy cap a reality, according to Moore.

    "We're really in a good place," he said. "Both the data and what we know about the profession and its value in health care set us up for an opportunity to permanently take the therapy cap off the books."

    For its part, the House subcommittee is reportedly supportive of repeal, with subcommittee Chair Michael Burgess (R-TX) saying he hopes to avoid enacting another therapy cap exceptions process. "Much like the sustainable growth rate formula, we have a policy inherent to the therapy cap that no one supports," Burgess told the subcommittee.

    The efforts of individual APTA members boost the odds of ending the therapy cap. One way to make a difference: take part in APTA's social media blitz to Congress beginning on July 24. Watch your Facebook and Twitter feeds for messaging and instructions on letting your legislators know how they can improve patient care through putting an end to the cap. And then keep the momentum going by downloading the APTA action app, visiting the association's Legislative Action Center, and learning about other advocacy involvement opportunities.