Therapy Caps Exceptions Process Extended for 2 Months: Advocacy Still Needed
By Stephanie Yamkovenko
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Therapy Cap Updates
Continue checking here for the latest updates. Last updated Dec. 23, 2011.
Both the House and Senate have approved an extenders package that includes a 2-month extension of the therapy cap exceptions process and SGR "doc fix." Current indications are that discussions will resume in January regarding a long-term solution for both the caps and SGR.
Grassroots advocacy over the next 2 months will be critical to ensure Congressional action on these issues. AOTA members should contact their elected officials and ask them to support a long-term solution for the Medicare Part B outpatient therapy caps. Take action now.
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This year has been more partisan than usual—with Democrats controlling the Senate and Republicans controlling the House. Despite Congress having a 9% approval rating, neither party seems willing to compromise on important legislative issues, resulting in a lawmaking gridlock.
One of those important issues affects occupational therapy practitioners and the clients we serve. The Medicare therapy cap sets an arbitrary limit—$1,880 a year in 2012—on the amount of occupational therapy a Medicare beneficiary can receive, putting the government between the patient and the health care provider. For more than 5 years, the American Occupational Therapy Association (AOTA) has advocated successfully for an extension to the therapy cap exceptions process, which allows beneficiaries with certain conditions to exceed the therapy cap limit.
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In April, AOTA was successful in having the Medicare Access to Rehabilitation Services Act introduced with bipartisan support in the House and Senate. The legislation would fully repeal the Medicare Part B Outpatient Therapy Cap and has the support of both Democrats and Republicans in both chambers of Congress.
In coalition with the American Physical Therapy Association (APTA) and the American Speech-Language-Hearing Association (ASHA), AOTA has been meeting with House and Senate committees to urge Congress to act.
The repeal legislation would be a good long-term solution and would ensure that only appropriate and beneficial therapy is provided without disregarding the clinician’s judgment on the amount and frequency of therapy services a client needs. The legislation has gained significant support by legislators, but a challenging political environment in Congress has made it difficult for the bill to pass.
“Congress has to do something,” says Tim Nanof, AOTA’s director of Federal Affairs. “Passage of the repeal legislation would be ideal, but an extension to the exceptions process for all of 2012 and beyond is a possible short-term solution to ensure beneficiaries have access to therapy services next year or two.”
AOTA needs every member to contact their legislators and urge them to take action to address the cap. Occupational therapy practitioners can take action now by visiting the Legislative Action Center for materials and form letters to send to Congress.
“Every practitioner can be affected by the therapy cap—no matter your work setting or whether you treat Medicare clients,” says Nanof. “Private and public payers use Medicare as a model for payment, and every occupational therapy practitioner should advocate for repealing the cap or extending the exceptions process so clients can receive the care they need.”
Stephanie Yamkovenko is AOTA’s staff writer.
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