WASHINGTON – U.S. Senators Ben Cardin (D-Md.) and Susan Collins (R-Maine) have re-introduced S. 539, 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.
“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. Arbitrary caps on these vital Medicare outpatient therapy services are simply unacceptable,” 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. Year after year, Congress has shown its disapproval for these arbitrary therapy caps.”
Senator Susan Collins, who Chairs the Senate Special Committee on Aging said, “This legislation would ensure appropriate access to important outpatient rehabilitation services under the Medicare program. I am concerned that the current, arbitrary caps could prevent Medicare beneficiaries recovering from a stroke, hip fracture, or other disease or conditions requiring extensive therapy from receiving all of the services they need. In addition, Medicare patients would have an incentive to seek services in the hospital outpatients setting, which are not subject to the caps and are more expensive. Arbitrarily capping these vital rehabilitation services would 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 persons with disabilities.”
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 12 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.
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 College of Rheumatology
American Health Care Association
American Heart Association/American Stroke Association
American Medical Rehabilitation Providers Association
American Occupational Therapy Association
American Physical Therapy Association (APTA)
American Speech-Language Hearing Association
Brain Injury Association of America
Focus On Therapeutic Outcomes, Inc. (FOTO)
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
“APTA applauds the bipartisan introduction of this legislation that would repeal the arbitrary cap on outpatient rehabilitation services,” said APTA President Paul A. Rockar Jr, PT, DPT, MS. “This legislation would help transform society by protecting patients and consumers from limits on therapy services so often needed after a stroke, traumatic brain injury, spinal cord injury, hip fracture, or to effectively manage conditions such as Parkinson disease, multiple sclerosis, or arthritis. It is critical therapy cap repeal provisions be included as Congress explores a final solution of the Sustainable Growth Rate (SGR) formula. We appreciate the Senators’ continued leadership in protecting Medicare beneficiaries’ access to services.”
Similar bipartisan legislation in the House of Representatives (H.R. 775) was introduced by Representatives Charles Boustany (R-La.), Xavier Becerra (D-Calif), Marsha Blackburn (R-Tenn.) and Lois Capps (D-Calif.).