Majority of U.S. House supports repeal of Medicare therapy caps

With about one month to go before the current exceptions process for clinically based care above the Medicare therapy caps expires, a majority of the U.S. House of Representatives has endorsed legislation to repeal the arbitrary financial limit on therapy benefits.

The Medicare Access to Rehabilitation Services Act of 2007 (HR 748) has reached 225 cosponsors. The bipartisan legislation was introduced by Assistant to the Speaker Xavier Becerra (D-CA), Minority Whip Roy Blunt (R-MO), and representatives Phil English (R-PA), Chip Pickering (R-MS), and Mike Ross (D-AR) in early 2007. Similar legislation led by Senators John Ensign (R-NV) and Blanche Lincoln (D-AR) with bipartisan support has also been introduced in the Senate (S 450) and currently has 42 sponsors. "We are encouraged that the majority of the House is in agreement about the severe restrictions that the therapy caps place on Medicare beneficiaries," said APTA President R Scott Ward, PT, Ph.D.

The Balanced Budget Act of 1997 imposed a $1,500 cap on outpatient therapy services that became effective in January 1999. In subsequent years Congress placed three separate moratoriums on the cap. In 2005, however, Congress voted for the therapy cap to go into effect; yet it also passed legislation authorizing the Centers for Medicare and Medicaid Service (CMS) to implement an "exceptions process," which permits medically necessary physical therapy, occupational therapy, and speech pathology services to exceed the cap if the patient meets certain diagnostic and clinical criteria.

Authorized by the Deficit Reduction Act of 2005, the exceptions process was extended in December 2006 by the Tax Relief and Health Care Improvement Act and again in 2007 through the Medicare, Medicaid, and SCHIP Extension Act. The exceptions process is scheduled to expire June 30, 2008. Without these exceptions, the cap would be set at $1,810 for physical therapy and speech-language pathology combined and $1,810 for occupational therapy services. For more information on the history of the therapy cap, please visit www.apta.org/advocacy.

The American Physical Therapy Association is a national organization representing physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can visit www.findapt.us to find a physical therapist in their area, as well as www.apta.org/consumer for physical therapy news and information.