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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Mind the Cap Please

Published December 6, 2012 1:00 PM by Rebecca Mayer
In the midst of all the turmoil in our country's healthcare system, the rehab sector is engaged in a battle to prevent Congress from imposing a hard therapy cap on Medicare-covered therapy. And the clock is ticking.

Unless Congress passes legislation, there will be a therapy cap with no exceptions process for all outpatient therapy settings except hospitals effective Jan. 1, 2013. Therapy caps, or established per-person Medicare spending limits, for nonhospital outpatient therapy, were first established by Congress in 1997 under the Balanced Budget Act (BBA).

Under these caps, Medicare covers a set dollar amount for outpatient physical therapy, occupational therapy, and speech-language pathology services. The current therapy cap is a combined $1880 for PT and SLP, and a separate $1880 for OT.

Congress has recognized the harm the therapy caps would cause and has voted several times to keep the caps from going into effect. Most recently, Congress voted to extend the therapy caps exception process through December 31, 2012. But will Congress do it again? That is the big question.

What is so bad about the therapy cap? For one, the cap limits Medicare patients to roughly two months of treatment at an outpatient therapy clinic. Imagine your 75-year-old father is recovering from a stroke-once his Medicare therapy cap is reached, his options are to forgo care, pay out of pocket or travel to an outpatient hospital clinic (which may be a long distance from his home) for continued care. This doesn't seem right when most stroke patients continue to make gains many months-or even years-after the initial event.

Unless Congress acts, the current therapy cap exceptions process will expire on Dec. 31, 2012.

There are many ways to get involved and time is of the essence:



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