APTA Supports Bill Including Therapy Cap, Fee Schedule Provisions, USA

Main Category: Medicare / Medicaid / SCHIP
Article Date: 09 Jan 2008 - 4:00 PDT

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Medicare patients received relief from arbitrary caps on rehabilitation services under legislation signed by President Bush. The American Physical Therapy Association (APTA) applauded the president and Congress for postponing inflexible financial limits - therapy caps without exceptions-on rehabilitation services and for reversing Medicare cuts for health professionals that were slated to begin on January 1. The Medicare, Medicaid, and SCHIP Extension Act of 2007 (S 2499), through June 30, 2008, extends the current therapy cap exceptions process and provides a 0.5% Medicare pay raise in place of a 10% cut.

"Congress and the President have recognized that arbitrary caps on rehabilitation services have the most devastating affect on Medicare patients most in need of treatment," said APTA President R Scott Ward, PT, PhD. "Although permanently repealing the therapy caps is the best long-term solution, this legislation will ensure seniors and disabled Americans are not forced to pay out-of-pocket expenses or alter their course of care. Combined with cuts in fee schedule payments, both patients and the physical therapy profession would have faced unprecedented challenges. The American Physical Therapy Association looks forward to working with Congress to completely repeal the caps - eliminating this threat once and for all."

Without action by Congress and the president, arbitrary financial limits on rehabilitative care would have continued beyond December 31, 2007, only now without exceptions for medically necessary treatments. Without these exceptions, the caps would limit Medicare coverage to $1,810 for physical therapy and speech-language pathology combined and $1,810 for occupational therapy services. The therapy caps originally were adopted by Congress in the Balanced Budget Act of 1997.

The legislation also prevents the scheduled reduction in payments to health care providers under the Medicare physician fee schedule's "sustainable growth rate." Health care professionals would have faced a 10.1% cut to the conversion factor, which determines Medicare payments. Instead, the new law authorizes a 0.5% rate increase through June 30, 2008. It also contains a variety of other provisions, including an 18-month extension of the State Children's Health Insurance Program, or SCHIP.

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 71,000 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 here.

American Physical Therapy Association