FOR IMMEDIATE RELEASE                                                                        Contact: Claire Navaro
December 6, 2011                                                                                                  (202) 898-6317

Congress’s Must-Pass List for 2011: Therapy Cap Extension

Congress must protect access to critical therapy services for Medicare beneficiaries, says long term care providers

Washington, DC - The long term care profession today called on Congress to act and extend the therapy cap exceptions process for medically necessary Medicare Part B outpatient therapy services. Extending the exceptions process would help ensure tens of thousands of beneficiaries receive the critical therapy services they need for their recovery, providers argue.

“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 (AHCA/NCAL). “The care provided to patients is as diverse and individualized as the patients themselves, and this essential step in the recovery process would be halted if Congress allows the cap to go into effect at the beginning of the new year.”

With a two-percent “trigger” cut to Medicare set by way of the super committee’s inability to develop a deficit reduction plan, skilled nursing facilities are already facing a stark reality. Now, as Congress looks to depart Washington by the end of December, several issues remain undecided, potentially impacting access to care for America’s seniors and disabled individuals even more.

As part of the Balance Budget Act of 1997 (BBA), annual payment caps on outpatient rehabilitation therapy services - speech-language pathology services, physical therapy, and occupational therapy - were established. Congress has repeatedly placed moratoria on these caps, and in the Deficit Reduction Act of 2005 (DRA) mandated that the Centers for Medicare & Medicaid Services (CMS) develop an "exceptions process" for Medicare beneficiaries with certain conditions who exceeded cap on Part B therapy services in 2006. Congress has had to extend authority for continued use of this exceptions process multiple times. The most recent extension of the therapy caps exceptions process was included in the Medicare & Medicaid Extenders Act of 2010, and is set to expire on December 31, 2011.

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 thousands of Medicare beneficiaries if Congress and the Administration are unable to reach agreement and extend the therapy cap exceptions process. Not doing so could also cause additional strain on the entire health care system, as many seniors would be prevented from regaining their full functionality and then require additional care in the near future.

“From recovering after a stroke to regaining independence after a fall, thousands of beneficiaries will hit this cap within a matter of weeks,” said Cynthia Morton, Executive Director of the National Association for the Support of Long Term Care (NASL). “We are ready and willing to work with Members of Congress on both sides of the aisle to ensure that our nation’s seniors and those with disabilities have access to the critical rehabilitative services they need.”

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