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Congress Must Extend Exceptions to Medicare Therapy Cap
February 4, 2010 • Volume 10, Issue 5
Effective January 1 of this year, people with Medicare face a $1,860 cap on the amount of physical and speech therapy they can receive during the year, as well as a separate $1,860 cap on occupational therapy. The therapy caps limit treatment for older adults and people with disabilities who need extensive therapy as they recover from a stroke or other acute episode, or suffer from chronic conditions such as Parkinson’s disease or multiple sclerosis.
Both the House and Senate health reform bills would have extended an exceptions policy that allows Medicare to pay for medically necessary therapy above the $1,860 cap. But with health reform stalled—at least temporarily—it is urgent for Congress to find another legislative vehicle to pass an extension of the exceptions policy. Without prompt action by Congress, people who need extensive therapy may soon see their therapy interrupted, resulting in real harm to their ability to function or recover from an injury.
Most members of Congress are aware of the urgency of acting now to prevent a 21 percent Medicare pay cut to doctors from taking effect on March 1. The therapy cap issue, however, has received relatively little attention. Please call or write your senators and representatives and urge them to extend the exceptions policy on Medicare therapy caps.
“The caps would hit hardest those patients who have the greatest need for rehabilitation therapy services, such as those who have suffered strokes or serious physical injuries and people with disabilities. Lawmakers have contacted the Obama administration saying some of their constituents have already exhausted their annual benefit just one month into the year.
“A beneficiary could go through that 1,860 [dollars] pretty quickly,” said Susan Feeney, a spokeswoman for the American Health Care Association (AHCA), which represents nursing homes.
“Above that level, beneficiaries are on the hook for 100 percent of the cost of their therapy unless they are also enrolled in Medicaid in a state that covers therapy services, she said. Patients undergoing therapy outside nursing homes can opt to seek treatment at a hospital, if one is available, but those in nursing homes cannot be discharged.” (Therapy benefit cap looms over patients and providers as healthcare bill stalled, The Hill, February 2010)
“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.” (Congress Urged to Take Immediate Action to Ensure Frail Patients Continue to Receive Critical Therapy Services, PR NewsWire, January 2010)
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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