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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Next Up: 2014 and the Affordable Care Act

Published November 7, 2012 12:40 PM by Lisa Lombardo

As President Obama has won a second term in office, the Affordable Care Act will now be going into effect in January of 2014. Several states have filed appeals or injunctions for waivers to opt out of all or some parts of the health care plan, but the decisions on those rulings have yet to be determined.

Proponents of the Act say that health care costs across the board will go down for most Americans, and that the Act will provide more options for health insurance at lower costs. The implementation of the Act will seemingly override the need for a Medicare cap on outpatient therapy, which still stands at $1,880 for physical therapy (PT) and speech-language pathology (SLP) services combined, and $1,880 for occupational therapy (OT) services.

Recent changes to the caps began October 1, 2012; Medicare contractors can review patients' medical records to check for medical necessity if a patient got outpatient therapy services in 2012 higher than $3,700 for PT and SLP combined, or $3,700 for OT.

Also as of October 1, 2012, the exemption ends and the outpatient therapy caps will apply to therapy services patients get in an outpatient hospital department or hospital emergency room and count toward the therapy cap limits. Source:

Combined with these recent changes, what do you think the impact will be once the Affordable Care Act goes into effect? Do you have more positive or negative feelings about your practice-in whatever capacity you work-now that the election is over?


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