Therapy Cap Bill Introduced in Congress Bipartisan legislation to repeal the annual cap on Medicare Part B outpatient rehabilitation therapy services was introduced into both the U.S. House of Representatives and U.S. Senate in April. The Medicare Access to Rehabilitation Services Act (H.R. 1546/S. 829) is sponsored by Reps. Jim Gerlach (R-Pa.) and Xavier Becerra (D-Calif.) ... Policy Analysis
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Policy Analysis  |   June 01, 2011
Therapy Cap Bill Introduced in Congress
Author Notes
  • Ingrida Lusis, director of federal and political advocacy, can be reached at ilusis@asha.org..
    Ingrida Lusis, director of federal and political advocacy, can be reached at ilusis@asha.org..×
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Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   June 01, 2011
Therapy Cap Bill Introduced in Congress
The ASHA Leader, June 2011, Vol. 16, 3. doi:10.1044/leader.PA.16072011.3
The ASHA Leader, June 2011, Vol. 16, 3. doi:10.1044/leader.PA.16072011.3
Bipartisan legislation to repeal the annual cap on Medicare Part B outpatient rehabilitation therapy services was introduced into both the U.S. House of Representatives and U.S. Senate in April. The Medicare Access to Rehabilitation Services Act (H.R. 1546/S. 829) is sponsored by Reps. Jim Gerlach (R-Pa.) and Xavier Becerra (D-Calif.) and Sen. Ben Cardin (D-Md.).
The Medicare cap on outpatient rehabilitation therapy services was instituted under the Balanced Budget Act of 1997. It establishes a maximum reimbursement level for speech-language pathology and physical therapy services combined, and a separate cap on occupational therapy services. Originally intended as a Medicare cost-control mechanism, the caps have not proven effective in reducing expenditures; instead, they have penalized the sickest of Medicare patients.
Congress has long recognized the detrimental effect of the caps and has provided short-term alternatives. For the past several years, Congress has enacted legislation that authorizes an exceptions process to the caps. This exceptions process allows the Centers for Medicare and Medicaid Services (CMS) to approve coverage of medically necessary services beyond the maximum reimbursement level. Most recently, Congress extended the Medicare therapy caps exceptions process through 2011. However, additional action must be taken before Dec. 31, 2011, to avert implementation of the cap on Medicare-covered therapy services.
CMS is working on developing alternatives to the current system. In response to calls to overhaul the caps and the exceptions process, CMS established a research project in 2008, “Developing Outpatient Therapy Payment Alternatives” (DOTPA), which may eventually develop alternatives to the current system. That five-year project is in the data-gathering phase.
Repeal of the therapy caps is a key objective in ASHA’s 2011 Public Policy Agenda, and the association continues to address the issue through a dual-track approach. In partnership with occupational and physical therapy groups, ASHA representatives have engaged CMS in discussions regarding an alternative payment system for Medicare outpatient therapy services. At the same time, ASHA continues to urge Congress to act on legislation that will eliminate the current uncertainty that makes it difficult for providers to plan for the future.
The legislation is not expected to pass in its current form. However, ASHA continues to work on securing cosponsors and ensuring that the therapy caps issue will be addressed in any end-of-year legislation that establishes Medicare rates and policies for 2012. In support of that effort, ASHA members are encouraged to contact their congressional representatives on this issue. Visit ASHA’s Take Action webpage for a quick and simple way to send a pre-written e-mail message to senators and representatives.
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June 2011
Volume 16, Issue 7