Thread: Medicare PT Cap
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Old 12-05-2005, 09:24 PM
cervie queen cervie  queen is offline
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On December 31, 2005 the current moratorium on enforcement of the Medicare therapy cap will expire. Without action by Congress, many senior citizens and people with disabilities who need physical therapy care the most may face a choice between forgoing necessary care or paying 100 percent out of pocket when their Medicare coverage runs out. The Senate has voted to extend the therapy cap moratorium by 1 year in its Budget Reconciliation package; the House has not included the provision in its version of the budget bill.

"The therapy cap discriminates against Medicare beneficiaries who are in the most need of physical therapy services," said APTA President Ben F Massey, Jr, PT, MA. "Patients with stroke, hip fracture, Parkinson disease, or any other condition that requires extensive rehabilitation are most likely to be affected by this short-sighted Medicare policy. Legislation repealing the therapy caps would solve this problem once and for all, but we are pleased that the Senate has recognized the need to protect Medicare beneficiaries from the effects of a therapy cap, even if it is a short-term solution. We hope the House will recognize the urgent need to take action this year."

A bipartisan group of members of the US Senate and US House of Representatives introduced The Medicare Access to Rehabilitation Services Act of 2005 (S 438 & HR 916) earlier this year to repeal the financial cap on Medicare outpatient physical therapy benefits. The legislation would eliminate the ongoing threat that would force a significant number of seniors and individuals with disabilities to delay or alter the course of their care by changing providers or facilities. The Medicare Access to Rehabilitation Services Act of 2005 currently has 38 cosponsors in the Senate and 203 cosponsors in the House.

The current moratorium is set to expire December 31, 2005, allowing the cap to be implemented on January 1, 2006, by the Centers for Medicare and Medicaid Services (CMS). Current law provides for two caps on rehabilitation benefits, one for physical therapy and speech therapy, and a separate cap for occupational therapy.
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