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Medicare News
Coalition Pressures Congress to Stop Medicares
Therapy Cap
Removing cap allows
seniors to apply for
rehab care above limit
 November 13, 2006 The high profile battles over
Medicare rules that have been taken to Congress for relief have been the
physicians and power wheelchair advocates trying to avoid pay cuts by
Medicare. In less than 50 days, however, one in seven Medicare
beneficiaries will be subject to an arbitrary financial limit on
outpatient rehabilitation services, unless a coalition formed by the
American Physical Therapy Association can get help from Congress.
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It is often referred to as the "therapy cap." The
APTA and a coalition representing patients, health care providers, and
advocates are calling on Congress to support an extension of the therapy
cap exceptions process to allow Medicare beneficiaries needing care
above the limit to apply for additional coverage.
"It is urgent that Congress takes action to protect
Medicare beneficiaries from an arbitrary therapy cap," said APTA
President R Scott Ward, PT, PhD.
"Data show that patients with stroke, hip fracture,
Parkinson's disease, and other conditions that require extensive
rehabilitation are most likely to be affected by the Medicare therapy
caps. APTA believes that the current therapy cap exceptions process has
maintained access to needed rehabilitation services in a fiscally
responsible manner.
APTA continues to advocate for the best long-term
solution to the arbitrary caps: full repeal of the therapy caps. But in
the current situation, Congress must take action immediately to, at a
minimum, extend the exceptions process for another year and protect our
patients from the arbitrary caps," Ward added.
There are two caps on rehabilitation coverage, one
for physical therapy and speech therapy combined and a separate cap for
occupational therapy.
Earlier this year, Congress passed a provision in
the Deficit Reduction Act that authorized the Centers for Medicare and
Medicaid Services (CMS) to implement an exceptions process to allow
beneficiaries who need care above the financial cap to apply for
additional medically necessary coverage -- but only through 2006.
Earlier this year, 179 members of the U.S. House of
Representatives and 46 U.S. Senators signed on to a letter urging an
extension of the therapy cap exceptions process, but neither the House
nor the Senate has passed legislation addressing the measure.
The American Physical Therapy Association is a
national professional organization representing nearly 70,000 members.
Its goal is to foster advancements in physical therapy practice,
research, and education.
Extension of the therapy cap exceptions process is
supported by over 40 patient and provider groups.
List of coalition members supporting an
extension of the Therapy Cap exceptions process:
(Organizations marked with an asterisk
will also be participating in advertisements on the issue running in
Capitol Hill publications this week.)
American Academy of Physical Medicine
and Rehabilitation*
American Academy of Neurology
Alzheimer's Association
American Association of Homes &
Services for the Aging
American Association on Mental
Retardation
American Dance Therapy Association
American Health Care Association*
American Heart Association/American
Stroke Association*
American Medical Directors Association
American Medical Rehabilitation
Providers Association*
American Music Therapy Association
American Network of Community Options
and Resources
American Nurses Association*
American Occupational Therapy
Association*
American Physical Therapy Association*
American Speech-Language and Hearing
Association*
American Therapeutic Recreation
Association
Amputee Coalition of America
Arthritis Foundation*
Brain Injury Association of America*
Catholic Health Association of the
United States
Center for Medicare Advocacy, Inc.
Christopher Reeve Foundation
Easter Seals*
HealthSouth
Military Officers Association of
America*
National Association for the Support
of Long Term Care*
National Association of Councils on
Developmental Disabilities
National Association of Directors of
Nursing Administration/LTC, Inc.*
National Association of Rehabilitation
Providers and Agencies*
National Association of Social Workers
National Association of State Head
Injury Administrators
National Council for Community
Behavioral Healthcare
National Disability Rights Network
National Multiple Sclerosis Society
National Osteoporosis Foundation*
National Rehabilitation Association
National Rural Health Association
National Stroke Association
Parkinson's Action Network*
Power Mobility Coalition
The Arc of the United States*
United Cerebral Palsy*
United Spinal Association
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