Press Release

April 14, 2011
Bill Would Repeal Arbitrary Outpatient Therapy Caps

WASHINGTON – U.S. Senator Ben Cardin (D-MD) today joined U.S. Senator Susan Collins (R-ME) to introduce legislation to ensure appropriate access to outpatient rehabilitation services under the Medicare program.  The bill would repeal the existing annual caps on physical therapy, occupational therapy, and speech-language pathology services.

“Arbitrary caps on vital Medicare services outpatient therapy have no place in medicine,” said Senator Cardin.  “These caps fail to take into account patients’ medical needs.   If Congress fails to act, they will have a serious effect on the progress of seniors who are recovering from strokes, hip fractures, or other serious medical conditions.”

Limits on outpatient rehabilitation therapy in Medicare were first imposed in 1997 as a budget-saving measure.   They were adopted without hearings and with no policy justification for the then-$1,500 limits.  Over the years, Congress has acted numerous times to prevent the caps from going into effect, most recently by extending an exceptions process for one year in the Medicare and Medicaid Extenders Act of 2010. 

“I am concerned that Medicare beneficiaries recovering from a stroke, hip fracture, or other disease or condition requiring extensive therapy will not be able to receive all of the services they need under these caps” said Senator Collins. “Moreover, 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.”

The Medicare Access to Rehabilitation Services Act of 2011 would guarantee beneficiaries access to physical and occupational therapy and speech-language services. Without further congressional action, the caps will take effect on January 1, 2012.  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.  If fully enforced, this policy would present a major hurdle to beneficiaries receiving the critical rehabilitation care they require to deal with an illness, such as Parkinson’s disease or stroke, or a debilitating injury such as a hip or joint fracture.

U.S. Congressmen Xavier Becerra (D-CA) and Jim Gerlach (R-PA) also will be introducing a similar measure today in the U.S. House of Representatives.

  Repeal of the Medicare therapy caps is supported by more than 30 organizations, including: the American Physical Therapy Association, the American Occupational Therapy Association, the American Association of Homes & Services for the Aging, the American Association of People with Disabilities, the American Heart Association/American Stroke Association, and the Autism Society.