Congressman Pomeroy Calls For Suspension Of Therapy Caps

Main Category: Rehabilitation / Physical Therapy
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 09 Nov 2007 - 4:00 PDT

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Medicare financial limits on critical rehabilitation services would be postponed under legislation introduced Tuesday by US Representatives Earl Pomeroy (D-ND), Shelly Moore Capito (R-WV) and Tom Allen (D-ME). These therapy caps on physical therapy, occupational therapy and speech-language pathology are scheduled to go into effect Jan 1, 2008. The Long Term Care Quality & Modernization Act of 2007(HR 4082), however, would extend an exceptions process based on the clinical judgment of health care providers.

"Caps on outpatient rehabilitation services have been shown to discriminate against the most vulnerable Medicare beneficiaries," said Pomeroy, the bill's lead sponsor. "Congress cannot allow arbitrary therapy caps to threaten seniors and disabled Americans with higher out-of-pocket costs and reduced access to the health care services they need."

The Long Term Care Quality & Modernization Act of 2007 would extend the exceptions process for the therapy caps, which 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 caps, or requiring them to ration their care to avoid exhausting their benefits. The arbitrary caps also shift costs to inpatient settings, reduce patients' abilities to remain independent in their homes and communities, and delay care, which results in the need for higher-cost interventions. Meanwhile, the caps discriminate 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.

"Patients in need of physical therapy should have their treatment determined by health care professionals - not arbitrary financial limitations," said American Physical Therapy Association President R Scott Ward, PT, PhD. "These barriers require seniors and individuals with disabilities to choose whether to pay the full cost for physical therapy or forgo needed treatment and a better quality of life."

HR 4082 also includes other quality improvement initiatives, such as promoting investment in capital improvements and assisting in alleviating the health care workforce shortage.

Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

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.

http://www.apta.org