A coalition of organizations representing consumers, health professionals and providers recently sent a letter to Congressional Leadership, calling for the immediate reinstatement of the exceptions process for Medicare Part B outpatient therapy services. Without such efforts, thousands of Medicare beneficiaries will exceed arbitrary limitations on physical therapy, occupational therapy, and speech-language pathology services.
"There is a critical need for uninterrupted Medicare therapy benefits, and we urge Congress to protect America's vulnerable populations from the adverse effects of arbitrary financial caps on medically-necessary rehabilitation services for Medicare beneficiaries," stated R. Scott Ward, PT, PhD, President of the American Physical Therapy Association (APTA).
"The long term care profession is deeply committed to enhancing the quality of care and services provided to high-acuity patients in our facilities, such as those patients recovering from strokes and joint replacements, and access to therapy services plays an integral role," stated Bruce Yarwood, President and CEO of the American Health Care Association (AHCA).
The letter from industry leaders indicates that 14.5 percent of Medicare beneficiaries who receive rehabilitation services per year are estimated to exceed the cap, and once the arbitrary limit on coverage is reached, many individuals with disabilities and senior citizens may have to forego necessary care.
"Patient needs are not arbitrary – and monetary caps on therapy do not take into account the importance of rehabilitation when it comes to returning Medicare beneficiaries to good health," stated Tommie L. Robinson, Jr. PhD, CCC-SLP, President of the American Speech-Language Hearing Association (ASHA). "Current law and its arbitrary ceiling for therapies limits access to care, and hinders Medicare beneficiaries' ability to recuperate."
According to the letter, Congress has repeatedly responded six times in the past to prevent Medicare beneficiaries from being negatively impacted by the therapy cap policy. This is a redundant task, organizational leaders said, that only temporarily resolves the issue, and ignores the need to permanently fix this problem for Medicare beneficiaries. While both the House and Senate versions of health care reform legislation addressed the therapy cap by expending the exceptions process for a short period of time, failure to enact reform has put beneficiaries who require rehabilitation after an illness or injury at considerable risk.
The letter also urges Congress to review options for repeal of the therapy caps as it prepares to modify its health care reform legislative proposal. Currently, Representatives Xavier Becerra (D-CA) and Roy Blunt (R-MO) have authored legislation to repeal the therapy caps, Medicare Access to Rehabilitation Services Act of 2009 (HR 43), which currently has one hundred and thirty cosponsors. A companion bill (S 46), introduced by Senators John Ensign (R-NV), Ben Cardin (D-MD) and Blanche Lincoln (D-AR), has twenty six cosponsors.
"We thank these Congressional champions for leading the fight in Congress to protect Medicare beneficiaries' access to critical rehabilitative services they need and deserve," stated Penelope Moyers Cleveland, EdD, OTR/L, BCMH, FAOTA, President of the American Occupational Therapy Association (AOTA).
American Health Care Association