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Congress Passes Therapy Cap Modification

Provision Authorizes CMS to Allow Exceptions to Therapy Caps

The American Physical Therapy Association (APTA) expressed its appreciation to Congress for passing legislation authorizing the Centers for Medicaid and Medicare Services (CMS) to provide an exception process for beneficiaries who need care above the current $1,740 cap on outpatient rehabilitation services. The House adopted this provision as part of the Deficit Reduction Act of 2005 (S. 1932) today.

"Medicare beneficiaries who need care should not have to worry about arbitrary limits on their therapy services. APTA is pleased that Congress has recognized the need to change the current law," said APTA President Ben F Massey, Jr, PT, MA. Massey added, however, that this was not a perfect bill, and the Association is concerned about the new exceptions process and its potential burden on Medicare beneficiaries. Although the process appears to be intended to make the caps less arbitrary, there is uncertainty regarding how the Secretary of Health and Human Services (HHS) will implement a process that allows individuals to obtain an exception to the uniform dollar limit. "We look forward to working with the secretary to ensure that this exception process allows patients to receive the physical therapy they need," Massey continued. "The new exceptions process is authorized through 2006 only -- providing a short term 'fix' for Medicare beneficiaries facing limits on their services. We are hopeful that Congress will recognize the need to completely repeal the caps -- providing a more permanent solution for Medicare beneficiaries needing physical therapy."

The therapy caps went into effect on January 1, 2006, limiting Medicare coverage on outpatient rehabilitation services to $1,740 for physical therapy and speech therapy combined and $1,740 for occupational therapy.

The American Physical Therapy Association is a national professional organization representing more than 65,000 members. Its goal is to foster advancements in physical therapy practice, research, and education.

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