Ensign, Becerra Call For Repeal Of Arbitrary Cap On Patient Care

Main Category: Medicare / Medicaid / SCHIP
Article Date: 04 Nov 2007 - 0:00 PDT

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Senator John Ensign (R-NV) and Congressman Xavier Becerra (D-CA) called on Congress to enact legislation abolishing Medicare financial limitations on vital health care services before the caps take effect at the end of this year. Financial caps on physical therapy, occupational therapy and speech-language pathology go into effect unless Congress extends the exceptions process beyond 2007 or fully repeals the cap by passing The Medicare Access to Rehabilitation Services Act (HR 748/S 450).

"Therapy is essential to the successful rehabilitation of seniors suffering from conditions such as stroke, Parkinson's disease and congenital heart failure," Ensign said. "Congress has demonstrated its opposition to these arbitrary limitations year after year. It's time to act for our seniors and ensure that they receive the rehabilitation services they need."

The Medicare therapy caps on outpatient rehabilitation services limit Medicare coverage of outpatient rehabilitation services to $1,780 for physical therapy and speech language pathology combined and $1,780 for occupational therapy services. The therapy caps were originally adopted by Congress in the Balanced Budget Act of 1997.

The therapy caps reduce beneficiaries' access to critical services by limiting their choice of providers, forcing them to bear 100 percent of the cost of care once they exceed the cap, or requiring them to ration their care to avoid exhausting their benefits. The arbitrary cap also shifts costs to inpatient settings, reduces patients' abilities to remain independent in their homes and communities, and delays care, which results in the need for higher-cost interventions. Meanwhile, the cap discriminates against the most vulnerable Medicare beneficiaries. Data show patients who have had a stroke, hip fracture, or multiple disabilities are most likely to be affected.

Congress has recognized the caps' potential harm to Medicare beneficiaries by passing moratoriums on enforcement several times. In 2006, Congress allowed the therapy caps to go into effect, but authorized Medicare to allow exceptions for additional, medically necessary coverage - but only through 2007. Congress must act on this legislation in 2007 to ensure patient access to rehabilitation services provided by physical therapists, occupational therapists, and speech-language pathologists.

"Studies show that arbitrary caps on Medicare services disproportionately affect patients with the greatest rehabilitation needs, such as those who experience stroke, hip fracture, or amputation," said American Physical Therapy Association President R Scott Ward, PT, PhD. "Repealing caps on critical rehabilitation services will eliminate the threat that seniors and disabled Americans will have to pay out-of-pocket expenses or compromise their care and recovery."

Stroke patients would be especially impacted by caps on Medicare coverage. More than 5.4 million Americans, including 4.4 million Medicare beneficiaries, are living with the consequences of stroke. Because individuals with stroke experience significant recovery, which leads to more independence and better quality of life, optimal recovery depends on good stroke care and therapies of sufficient duration, intensity and frequency.

"Arbitrary caps on rehabilitation therapies may in fact increase the financial burden for Medicare," said Pamela Duncan, PT, PhD, chair of the American Heart Association/American Stroke Association Stroke Council. "The current exceptions process, which expires at the end of this year unless Congress acts to extend it, has been an effective way of ensuring that stroke patients aren't denied needed care."

Senator Ensign and Congressman Becerra spoke at an advocacy briefing sponsored by the American Physical Therapy Association, American Heart Association/American Stroke Association, American Health Care Association, American Occupational Therapy Association, American Speech-Language-Hearing Association, Easter Seals, and the National Association for the Support of Long Term Care.

The American Physical Therapy Association is a national organization representing more than 72,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access "Find a PT" to find a physical therapist in their area, as well as physical therapy news and information at http://www.apta.org/consumer.

American Physical Therapy Association