February 01, 2017

Cardin, Collins, Casey, Heller Renew Call for an End to Caps on Therapy Services

Until these caps are fully repealed, patient access to medically necessary rehabilitation services will continue to be threatened

WASHINGTON – U.S. Senators Ben Cardin (D-Md.), Susan Collins (R-Maine), Bob Casey (D-Penn.), and Dean Heller (R-Nev.) have re-introduced the Medicare Access to Rehabilitation Services Act, which would protect Medicare beneficiaries from arbitrary limits on outpatient physical therapy, occupational therapy, and speech-language pathology services that are often needed to recover from debilitating illnesses, such as stroke, or support the effective management of conditions including multiple sclerosis and arthritis. The full bill text is available here.

“Arbitrary caps on vital Medicare outpatient therapy services are simply unacceptable. We need a full repeal of the existing caps on physical therapy, occupational therapy, and speech-language pathology services. These annual financial caps limit services often needed after a stroke, traumatic brain injury, or spinal cord injury, or to effectively manage conditions such as Parkinson’s disease, multiple sclerosis, and arthritis,” said Senator Cardin, a member of the Finance Health Care Subcommittee. “We should be helping seniors receive services necessary to resume their normal lives, not erecting road blocks to recovery. Congress needs to finally take action.”

"An arbitrary cap on therapy that can help a senior or a younger person disabled by an illness or accident to regain abilities makes no sense,” said Senator Collins.  “This legislation would ensure appropriate access to important outpatient rehabilitation services under the Medicare program to ensure that beneficiaries recovering from a stroke, hip fracture, or other diseases or conditions requiring extensive therapy can receive all of the services they need.  In addition to improving the health and well-being of seniors, rehabilitation is also more cost effective than similar services provided in the hospital outpatient setting, which are not subject to the caps.”

“This legislation will make sure that Medicare beneficiaries get the care they need following a major medical event,” Senator Casey said. “A senior recovering from a surgery or stroke can need a substantial amount of physical therapy or other services and this legislation will work towards making sure they get it.”

“Standing up for seniors in Nevada and across the country is always a top priority of mine. Currently, limits on therapy services provided by Medicare make it difficult for senior citizens to get the care they need following a serious illness. Eliminating arbitrary caps on therapy care will give seniors flexibility to pursue health care options that fit their needs and provide for the quality of life that they deserve,” said Senator Heller.

Limits on outpatient rehabilitation therapy services under Medicare were first imposed in 1997 as part of the Balanced Budget Act.  The decision to impose limits on these services was not based on data, quality-of-care concerns, or clinical judgment—its sole purpose was to limit spending in order to balance the federal budget.  Since 1997, Congress has acted over 16 times to prevent the implementation of the therapy caps through moratoriums and an exceptions process.  While these short-term actions have provided necessary relief to our seniors, a long-term solution is essential to bring permanent relief and much-needed stability for both patients and providers.

In a 2009 report issued by the Medicare Payment Advisory Committee (MEDPAC), it was estimated that the therapy cap, if enforced without an exceptions process, could negatively impact 931,000 Medicare beneficiaries.  Arbitrarily capping outpatient rehabilitation therapy services would likely cause some beneficiaries to delay necessary care, force others to assume higher out-of-pocket costs, and disrupt the continuum of care for many seniors and individuals with disabilities.

“America’s opioid epidemic has underlined the importance of removing barriers to safe health care and preserving patient choice. It is time for Congress to repeal, once and for all, the harmful therapy cap policy that limits access for Medicare beneficiaries to necessary rehabilitation services,” said the American Physical Therapy Association's CEO, Justin Moore, PT, DPT. “We thank Senator Cardin and other champions of this issue for their strong support over the years and urge Congress to support their efforts to repeal."

The Medicare Access to Rehabilitation Services Act is supported by a broad coalition of organizations representing the interests of patients, consumers and health care providers, including:

American Academy of Physical Medicine and Rehabilitation

American Health Care Association

American Heart Association/American Stroke Association

American Hospital Association

American Medical Rehabilitation Providers Association

American Occupational Therapy Association

American Physical Therapy Association (APTA)

American Speech-Language Hearing Association

Arthritis Foundation

Brain Injury Association of America

Easter Seals

Falling Forward Foundation

Focus On Therapeutic Outcomes, Inc. (FOTO)

Hydrocephalus Association

LeadingAge

Michael J. Fox Foundation

National Association of Rehabilitation Providers and Agencies

National Association of State Head Injury Administrators

National Association for the Support of Long Term Care

National Stroke Association

National Center for Assisted Living

Private Practice Section of APTA

PTPN (Physical Therapy Provider Network)

The ALS Association

United Spinal Association

Similar bipartisan legislation in the House of Representatives was introduced Wednesday by Representatives Eric Paulsen (R-Minn.) and Rep. Ron Kind (D-Wis.).

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