Perspective               

Medicare Physical Therapy Cap Upheld In Federal District Court

On September 29th, a federal district court judge ruled that the Bush Administration could enforce Medicare coverage caps on physical, speech, and occupational therapy. One cap prevents Medicare from covering more than $1,590 a year for outpatient occupational therapy. The other cap prevents Medicare from covering more than $1,590 a year for outpatient speech and physical therapy combined.

Last June, the Medicare Rights Center, Easter Seals, and the American Parkinson Disease Association sued the Bush Administration in federal district court to block the coverage cap on the grounds that people with Medicare had not been notified that the caps were going into effect. To settle the case, the Bush Administration agreed to delay implementation of the coverage caps until at least 90 percent of the 41 million people with Medicare were advised that the caps were going into effect. Contrary to the government’s pledge, far fewer than 90 percent of people with Medicare were advised of the new limitation. However, the latest ruling reflects the judge’s opinion that the Administration actually did fulfill its promise, by asking Medicare carriers to alert their older and disabled customers of the caps.

Almost 50 senators and a majority of House members are sponsoring a bill to repeal the caps. But until the caps are repealed, people with Medicare can only receive $1,590 in covered outpatient occupational therapy and $1,590 in outpatient speech and physical therapy combined between September and December of this year. The outpatient therapy limits apply to therapy received at therapists’ or physicians’ offices, outpatient rehabilitation facilities, skilled nursing facilities for outpatients or residents without Medicare-covered stays, and to therapy received at home when the patient is not covered by the Medicare home health benefit.

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