Therapy Caps: A Notion of the Past?

New legislation has been introduced that marked a watershed in the ongoing battle for the removal of Medicare therapy caps. The bill, titled the Medicare Access to Rehabilitation Services Act of 2007, was introduced in the Senate and House of Representatives on January 31, 2007. The bill calls for a complete removal of the law that placed caps on Medicare outpatient physical therapy, occupational therapy, and speech-language pathology. The law is a huge stride for Medicare beneficiaries across the country; this is the first attempt at a permanent fix to the Medicare therapy cap problem. The therapy caps were originally introduced in the Balanced Budget Act of 1997. Besides obvious budget problems, one of the main reasons the caps were introduced was to fight against over treatment of patients by doctors, but many factors were overlooked with the introduction of the legislation. Legislation was passed in 2006 to put these caps into effect, but they also authorized Medicare to exercise an “exception process.” These exception processes involved extending treatment passed the caps “if they meet diagnostic and clinical criteria.” In December 2006, new legislation was introduced, the Tax Relief and Health Care Improvement Act, which extended the exception process for the year of 2007. These legislations were just temporary fixes for the problem.

The new bill calls for a permanent fix; it calls to completely wipe out the therapy caps. Scott Ward, the president of the APTA, commented that “passing this important legislation to completely repeal the therapy caps is the best long-term policy solution- rather than passing 1-year fixes.” Currently, the limits are set at $1,780 for physical and speech therapy combined and $1,780 for occupational therapy. What this means for patients is that once they reach this therapy cap, they are forced with the difficult decision of paying out of pocket for the treatments or avoiding the necessary treatments altogether. People with serious injuries who require extensive ongoing treatment are mostly affected by these caps, and avoiding necessary treatment may put them in the surgery room. As Ward stated, removal of the therapy caps “would eliminate the ongoing threat to seniors and individuals with disabilities who may have to pay out-of-pocket expenses or alter the course of their care by changing providers or facilities.”

The new legislation is the result of intensive efforts made by the AOTA (the American Occupational Therapy Association) as well as members of Congress. The bill is gaining wide support from both Republicans and Democrats across the Senate and House of Representatives. In the senate, the chief sponsors are Senators John Ensign (NV), Blanche Lincoln (AR), Ben Cardin (MD), and Susan Collins (ME). In the House of Representatives, the chief sponsors, led by Representative Xavier Beccerra of California (pictured above), are Representatives Phil English (PA), Mike Ross (AR), Chip Pickering (MS), and Roy Blunt (MO). Representative Ross (pictured to the right) stated “whether a person receives speech, occupational or physical therapy, it should be a decision made between a doctor and patient, not by accountants monitoring a set limit.” This is a crucial point and is one of the main reasons behind this new bill. The current “exception process” extension expires on December 31, 2007, and for the new bill to be addressed before then, the AOTA, along with other organizations, require considerable grassroots action in order to encourage members of Congress to support the new legislation. It is not going to be an easy journey, but if successful, it will mark the end of physical, occupational, and speech therapy caps for good.