WASHINGTON – U.S. Senators Ben Cardin (D-MD) and Susan Collins (R-ME) have re-introduced legislation to protect Medicare beneficiaries from arbitrary limits on outpatient therapy services that are often needed to recover from debilitating illnesses, such as stroke, and that are important to the effective management of conditions such as multiple sclerosis and arthritis.
The Medicare Access to Rehabilitation Services Act, S.367, would permanently repeal the $1,900 therapy “caps” imposed on physical therapy, occupational therapy, and speech-language pathology services. Physical therapy and speech language pathology services are subject to a combined cap, and a separate cap is applied to occupational therapy. The caps, originally set at $1,500 in the 1997 Balanced Budget Act, were not justified by policy considerations and were applied without consideration for quality of care or clinical judgment. Since 1997, Congress has attempted — multiple times — to forestall the negative consequences of the caps, first through moratoria and now through an exceptions process that permits specific cases to be excluded from the limits.
“Rehabilitation therapies are critical to helping millions of Americans recover from injuries and debilitating illnesses,” said Senator Cardin, a member of the Finance Committee. “We should be helping seniors receive services necessary to resume their normal lives, rather than erecting road blocks to recovery. Year after year, Congress has shown its disapproval for these arbitrary therapy caps by enacting short-term fixes. Until these caps are fully repealed, patient access to medically necessary rehabilitation services will continue to be threatened. We have an opportunity with this legislation to eliminate them permanently.”
“I have long been concerned about the potential for harm posed by this unfair and arbitrary cap on outpatient rehabilitation services, particularly for our frailest Medicare patients,” said Senator Collins (R-ME). “Medicare patients recovering from a stroke, hip fracture or other disease or condition requiring extensive therapy may not be able to receive all of the services they need under the current cap, and it is time for Congress to enact a long-term solution to this problem.”
“The American Physical Therapy Association (APTA) applauds Senators Cardin and Collins for reintroducing this important piece of legislation, which will ensure patient access to medically necessary rehabilitation services,” said APTA President Paul A. Rockar, Jr, “APTA is hopeful that this will be the final introduction of this important legislation and that Congress will act to find a long-term solution to the cap this year.”
“The therapy cap is among the most serious restrictions on access to care under Medicare law,” said American Speech-Language-Hearing Association (ASHA) President Patricia A. Prelock, PhD. “If Medicare beneficiaries are to receive comprehensive quality health care, they must have access to speech-language-pathology services, occupational therapy, and physical therapy. ASHA applauds Senator Cardin for his continued leadership to ensure such vital access.”
“Senators Cardin and Collins know therapy is essential to full recovery from stroke or heart disease or to preventing a bad fall. This bill takes a stand against a bad policy and for good health. Therapists and beneficiaries appreciate his continuing leadership on this issue,” said Fred Somers, Executive Director, American Occupational Therapy Association.
A companion bill has been introduced in the U.S. House of Representatives by Congressmen Jim Gerlach (R-PA) and Xavier Becerra (D-CA).