New Congress Eyes Therapy Cap Bills Legislation to repeal the Medicare Part B therapy caps—which place financial restrictions on outpatient services including speech-language pathology—has been introduced in the U.S. House of Representatives and the Senate. Rep. Xavier Becerra (D-Calif.) and Sen. John Ensign (R-Nev.) introduced the Medicare Access to Rehabilitation Services Act (S. 46/H.R. 43) that ... Policy Analysis
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Policy Analysis  |   March 01, 2009
New Congress Eyes Therapy Cap Bills
Author Notes
  • Ingrida Lusis, is director of federal and political advocacy. Contact her for more information on ASHA’s legislative efforts at ilusis@asha.org or 800-498-2071, ext. 5610.
    Ingrida Lusis, is director of federal and political advocacy. Contact her for more information on ASHA’s legislative efforts at ilusis@asha.org or 800-498-2071, ext. 5610.×
  • Kate Romanow, is director of health care regulatory advocacy. Contact her at kromanow@asha.org or 800-498-2071, ext. 5612.
    Kate Romanow, is director of health care regulatory advocacy. Contact her at kromanow@asha.org or 800-498-2071, ext. 5612.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   March 01, 2009
New Congress Eyes Therapy Cap Bills
The ASHA Leader, March 2009, Vol. 14, 1-36. doi:10.1044/leader.PA.14032009.1
The ASHA Leader, March 2009, Vol. 14, 1-36. doi:10.1044/leader.PA.14032009.1
Legislation to repeal the Medicare Part B therapy caps—which place financial restrictions on outpatient services including speech-language pathology—has been introduced in the U.S. House of Representatives and the Senate.
Rep. Xavier Becerra (D-Calif.) and Sen. John Ensign (R-Nev.) introduced the Medicare Access to Rehabilitation Services Act (S. 46/H.R. 43) that would repeal the Medicare Part B therapy caps. The legislation was introduced shortly after the 111th Congress convened in January.
The Senate bill has drawn bipartisan support, with 11 senators signing on as original co-sponsors. In addition to Ensign, they include Daniel Akaka (D-Hawaii), Ben Cardin (D-Md.), Robert Casey (D-Pa.), Susan Collins (R-Maine), Richard Durbin (D-Ill.), Lindsey Graham (R-S.C.), Patrick Leahy (D-Vt.), Blanche Lincoln (D-Ark.), Sheldon Whitehouse (D-R.I.), and Debbie Stabenow (D-Mich.). At press time the bill had 13 co-sponsors.
The House bill was introduced with two original co-sponsors, Roy Blunt (R-Mo.) and Mike Ross (D-Ark.), and had 15 co-sponsors at press time.
Without congressional action the current therapy cap exceptions process is set to expire Dec. 31, 2009. The cap on outpatient rehabilitation therapy services for Medicare beneficiaries was originally instituted under the Balanced Budget Act of 1997 as a combined cap on speech-language pathology and physical therapy (PT) services, with a separate cap on occupational therapy (OT).
The original $1,500 cap on Part B Medicare therapy services was intended as a cost-control mechanism, but has not proved effective in saving Medicare money. Instead, it has punished the sickest of Medicare patients and denied them needed care. Congress has recognized that a financial limitation on therapy services is detrimental to Medicare patients and, through the years, has placed numerous moratoria on its implementation through the exceptions process.
Last July, as part of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), the exceptions process was extended through 2009. The exceptions process allows beneficiaries to access medically necessary outpatient therapy services above the cap.
The Centers for Medicare and Medicaid Services (CMS) has projects underway to develop both long- and short-term alternatives to the therapy caps. ASHA is actively involved in both of these projects to ensure that any new proposed payment policies will continue to ensure appropriate access to medically necessary speech-language pathology services.
Your help is needed to gain more co-sponsors for these bills. Please visit ASHA’s Take Action Web site to contact your members of Congress and request that they become co-sponsors of this important legislation.
For more information on the exceptions process, visit ASHA’s Web site.
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March 2009
Volume 14, Issue 3