Countdown to
Medicare Therapy Benefits Cap
ALEXANDRIA, VA -- 09/22/2005 -- In 100 days, the current
moratorium on enforcement of the Medicare therapy cap will
expire. Without action by Congress, many senior citizens and
people with disabilities who need physical therapy care the
most may face a choice between forgoing necessary care or
paying 100 percent out of pocket when their Medicare
coverage runs out.
"The
therapy cap discriminates against Medicare beneficiaries who
are in the most need of physical therapy services," said
APTA President Ben F Massey, Jr, PT, MA. "Patients with
stroke, hip fracture, Parkinson disease or any other
condition that requires extensive rehabilitation are most
likely to be affected by this short-sighted Medicare policy."
A bipartisan
group of members of the US Senate and US House of
Representatives introduced The Medicare Access to
Rehabilitation Services Act of 2005(S 438 & HR 916) earlier
this year to repeal the financial cap on Medicare outpatient
physical therapy benefits. The legislation would eliminate
the ongoing threat that would force a significant number of
seniors and individuals with disabilities to delay or alter
the course of their care by changing providers or
facilities. Senators John Ensign (R-NV) and Blanche Lincoln
(D-AR) introduced the Senate legislation and Representatives
Phil English (R-PA), Ben Cardin (D-MD), Roy Blunt (R-MO),
and Frank Pallone (D-NJ), introduced the House legislation.
The Medicare Access to Rehabilitation Services Act of 2005
currently has 34 cosponsors in the Senate and 170 cosponsors
in the House.
"Congress has
delayed implementation of the cap three times by placing a
moratorium on its enforcement. Congress has only a few
legislative days to do what is right by preventing this
benefit cut from taking place," said Massey.
The current
moratorium is set to expire December 31, 2005, allowing the
cap to be implemented on January 1, 2006, by the Centers for
Medicare and Medicaid Services (CMS). Current law provides
for two caps on rehabilitation benefits, one for physical
therapy and speech therapy and a separate cap for
occupational therapy.
What Congress
is Saying:
US Rep. Benjamin L Cardin (D-MD)
"I am extremely disappointed
that Congress has failed to deal with the many pressing
issues affecting Medicare beneficiaries," said US Rep.
Benjamin L Cardin (D-MD). "Failure to address the impending
therapy caps jeopardizes the well-being of our seniors and
their access to appropriate care. Congress needs to move
quickly to repeal these arbitrary limits."
US House Majority Whip Roy Blunt
(R-MO)
"Many past reforms to the
Medicare system focused on purse strings, rather than
patients. This legislation seeks to rectify that situation.
We can be fiscally responsible and attend to patients' needs
at the same time," said US House Majority Whip Roy Blunt
(R-MO).
US Rep. Phil English (R-PA)
"The therapy cap is
particularly devastating for the oldest and frailest
Medicare beneficiaries who need and benefit from these
services the most. 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," said US Rep. Phil English (R-PA).
US Senator Blanche Lincoln
(D-AR)
"The therapy cap is unfair to
our most vulnerable seniors and disabled Americans," said US
Senator Blanche Lincoln (D-AR)."I have supported complete
repeal of the therapy cap since it was first enacted. In the
Medicare Modernization Act of 2003, which passed with my
support, Congress extended a moratorium on the therapy cap
until January 1, 2006. Without Congressional intervention,
the therapy cap moratorium will expire on December 31 of
this year. Our legislation would repeal this unfair cap for
good."
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