Important Step Taken to Repeal the Therapy Cap More Action Needed to Guarantee Passage by the End of the Year


At the end of October, the three Congressional Committees that oversee the Medicare Outpatient Therapy Cap announced that they had reached a bi-partisan bicameral (both House and Senate) agreement on a policy framework that would permanently repeal the therapy cap.

The draft policy, which must still go through the usual legislative process, would repeal the therapy caps but continue with some activities to assure appropriate utilization: requiring an appropriate modifier (the KX modifier) certifying medical necessity and reasonableness, and continuing the current system of targeted review of claims over a $3,000 threshold. AOTA supports this framework for a permanent repeal of the Medicare therapy cap.

AOTA has been working hard with staff in both the House and Senate, and the Committees have made repealing the therapy cap a priority. A study done through AOTA early in 2017 has been used by staff to make judgments about how to craft the policy. The proposal has not yet been introduced as legislation.

“We appreciate the hard work of the committees to draft this policy. We must continue to work to assure that this hard work of so many comes to fruition in law over the next months,” said Christina Metzler, AOTA Chief Public Affairs Officer. “Crafting this approach is step one. Beyond this agreement, there are many more hurdles ahead such as the legislative calendar, what legislative vehicle will be used to move this forward, and how Congress will pay for it.”

For the past 20 years after the passage of the Balanced Budget Act in 1997, there has been a threat that consumers would be limited in the amount of occupational, physical, and speech-language pathology therapy they could receive under Medicare Part B. Congress has kept this limit or “cap” from going into effect, but should Congress fail to act by the end of 2017, a cap will go back into place. AOTA has worked alongside the American Physical Therapy Association (APTA), the American Speech-Language-Hearing Association (ASHA) and a coalition of consumer organizations to repeal the arbitrary and harmful barrier to care for a wide spectrum of Americans in need of rehabilitation and habilitation services.

With so many issues taking up Congressional attention, we need to make sure that repealing the therapy cap is a priority for 2017. We need your help to get a permanent repeal of the therapy cap signed into law.  Write to your Member of Congress and urge them to support a permanent repeal today!