American Physical Therapy Association Applauds Sen Baucus For Standing Up Against Therapy Cap

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Rehabilitation / Physical Therapy
Article Date: 04 Jul 2008 - 13:00 PDT

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The American Physical Therapy Association (APTA) applauds Senator Max Baucus (D-MT) for urging the Centers for Medicare and Medicaid Services (CMS) to maintain the exceptions process to Medicare Part B therapy caps in a letter sent yesterday to Health and Human Services (HHS) Secretary Michael Leavitt.

"Physical therapists thank Senator Baucus for his strong leadership in fighting an arbitrary financial limit on therapy services that do not account for the patients' clinical needs," said APTA President R Scott Ward, PT, PhD. "This arbitrary limit would have the greatest impact on those patients who need the care the most to recover and rehabilitate from injuries, impairments, and disabilities." Ward added, "Congress has long recognized that the therapy caps are bad policy. In the past, moratoriums have been passed or an exceptions process could be utilized by those patients requiring additional services. In failing to pass legislation to assure that beneficiaries continue to get the therapy care they need, Congress has placed the health of many seniors and persons with disabilities in jeopardy."

In a letter to HHS Secretary Michael Leavitt, Senator Baucus urged the delay of the enforcement of the caps, stating: "I write today to...allow the exception process to remain in place until Congress acts to extend the moratorium and reinstate the exception process. Alternatively, I ask that you delay processing claims for therapy services provided to beneficiaries subject to the cap. With strong bipartisan support, Congress has consistently acted to prevent therapy caps from going into effect and is on the verge of doing so again." Baucus also requested that the exception process be extended for seniors who require therapy services beyond the limits, stating "H.R. 6331...contains an 18-month extension of the exception process. I respectfully request that the Centers for Medicare and Medicaid Services maintain the exception process to the therapy caps or delay processing relevant claims until Congress has the opportunity to act following the Independence Day recess."

Outpatient physical therapy, occupational therapy, and speech-language pathology services provided in practice settings other than hospital outpatient departments are now subject to a financial limit, or "cap" of $1,810 as of July 1, 2008. There are no longer moratoriums on the cap or an exceptions process in place to be used by patients who require these services.

More than 700,000 Medicare beneficiaries will exceed their limit on Part B outpatient therapies this year because therapy services provided during the first six months of this year are included in the cap even though the services were provided under the earlier exception. This will force patients to pay out of pocket for therapy services or even to postpone or neglect getting the treatment they need.

Ward concluded, "We join Sen Baucus in working on behalf of Medicare patients. We will explore all viable options for keeping these policies from harming patients, and we urge Congress to come to a speedy resolution when it reconvenes in July and pass legislation that remedies this critical situation."

APTA 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 http://www.findapt.us to find a physical therapist in their area, as well as http://www.apta.org/consumer for physical therapy news and information.

American Physical Therapy Association