Therapy Cap is Bad Public Policy

Seniors and persons with disabilities are subject to an annual financial limit on outpatient physical therapy and speech language pathology services and a separate limit on occupational therapy services under the Medicare program. The current “cap” on these therapy services is $1860. To ensure beneficiary access to medically necessary rehabilitation services beyond the arbitrary caps, Congress established a therapy cap exceptions process in 2006.  Congress has extended the exceptions process several times.

• Discriminate against the oldest and sickest Medicare beneficiaries
• Deny access to essential care for our most vulnerable citizens
• Force the 12-13 percent of the beneficiaries that need therapy services beyond the arbitrary cap to ration their care or forgo medically necessary care altogether
• Punish patients suffering from stroke or other circulatory-related ailments, Parkinson's disease and musculoskeletal disorders, such as osteoporosis, who tend to require more care
• Push beneficiaries requiring services above the cap into seeking care in outpatient hospital settings if it is available to their area
• Limit access to necessary therapy for patients requiring more than one episode of therapy care in a year - not uncommon for Medicare beneficiaries 

The uncertainty that has surrounded the therapy cap issue during the past decade, points toward a compelling need for the Centers for Medicare and Medicaid Services (CMS) to modernize its payment policies for therapy services by developing and implementing a permanent, condition-based payment system that would ensure that frail and elderly patients have access to medically necessary rehabilitative care.

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