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Provider groups: 'Congress must pass therapy caps extension' before Jan. 1

December 7, 2011
by root
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In a joint statement Tuesday, several LTC provider associations urged Congress to extend the therapy cap exceptions process for medically necessary Medicare Part B outpatient therapy services, which is set to expire on December 31 and could negatively affect “tens of thousands of beneficiaries.”

“As 2011 draws to a close, one item on Congress’ must-pass list has to be exemptions to therapy caps,” said Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living. Parkinson was joined by Cynthia Morton, Executive Director of the National Association for the Support of Long Term Care, in calling for the extension.

According to the joint statement, therapy caps of $1,870 for physical therapy and speech-language pathology combined—and a separate $1,870 cap for occupational therapy—will place “significant hardships” on Medicare beneficiaries. The caps could also cause “additional strain on the entire healthcare system” if seniors are forced to leave therapy prematurely, the associations argued.

“From recovering after a stroke to regaining independence after a fall, thousands of beneficiaries will hit this cap within a matter of weeks,” Morton said.

Annual payment caps on outpatient rehabilitation therapy services were established as part of the Balanced Budget Act of 1997. Congress has repeatedly placed moratoria on these caps, and in the Deficit Reduction Act of 2005 mandated that the Centers for Medicare & Medicaid Services develop an “exceptions process” for Medicare beneficiaries with certain conditions who exceeded the cap on Part B therapy services in 2006. Congress has since extended authority for continued use of this exceptions process multiple times.

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