Medicare Update

Medicare Physical Therapy Cap Update (7/23/03)

Senior citizens across the country who are in need of physical therapy services achieved an important milestone today as four members of the U.S. House of Representatives joined in cosponsoring legislation to repeal the $1,590 Medicare therapy cap. With the endorsement of 220 Representatives, the Medicare Access to Rehabilitation Act (HR1125) now has the support of a majority of the members of the House, the American Physical Therapy Association (APTA) said. "The fact that a bipartisan majority of the House of Representatives has stepped up to endorse this legislation sends a message that is too loud and clear for the Medicare conferees to ignore ¾ Congress must take action now to prevent the imposition of the therapy cap," said APTA President Ben F Massey, Jr, PT, MA. "Coupled with the very strong support the repeal legislation is receiving in the Senate (S569), members of Congress clearly understand that the therapy cap would harm beneficiaries.

The House legislation, introduced by Representatives Phil English (R-PA), Ben Cardin (D-MD), Roy Blunt (R-MO), and Frank Pallone (D-NJ), would repeal the arbitrary $1,590 cap on Part B outpatient rehabilitation (physical therapy, occupational therapy and speech-language pathology services) under Medicare. Approximately 13 percent of seniors and individuals with disabilities would have to pay for therapy services out-of-pocket. A companion bill (S569) introduced by Senators John Ensign (R-NV) and Blanche Lincoln (D-AR) is nearing a majority in the Senate, with 44 senators currently supporting the bill.

The backing of a bipartisan majority of the House may strengthen the position of House conferees on another piece of pending legislation, the Medicare Prescription Drug and Improvement Act (H.R. 1), which includes a House provision to impose a one-year moratorium on implementation of the Medicare therapy cap in 2004. In 1997, Congress capped the benefit for outpatient rehabilitation services at $1,500 in all practice settings except hospitals in an attempt to balance the federal budget. Congress has twice imposed a moratorium on enforcement of the cap due to concerns raised by beneficiaries and health care professionals. In 1999, Congress placed the cap under a 2-year moratorium and extended it for another year in 2000. The moratorium expired on January 1, 2003. However, the Centers for Medicare and Medicaid Services (CMS) have twice delayed implementation of the cap. It is now scheduled to go into effect September 1, 2003, meaning that the $1,590 cap for this year will apply only to the last four months of the year.

Source: American Physical Therapy Association July 23, 2003