Sens. Collins, Cardin, Casey, and Heller Renew Call for an End to Caps on Therapy Services under Medicare

Until these caps are fully repealed, patient access to medically necessary rehabilitation services will continue to be threatened

Washington, D.C. — U.S. Senators Susan Collins (R-ME), Ben Cardin (D-MD), Bob Casey (D-PA), and Dean Heller (R-NV) have re-introduced the Medicare Access to Rehabilitation Services Act, which would protect Medicare beneficiaries from arbitrary limits on outpatient physical therapy, occupational therapy, and speech-language pathology services that are often needed to recover from debilitating illnesses, such as stroke, or support the effective management of conditions including multiple sclerosis and arthritis.

"An arbitrary cap on therapy that can help a senior or a younger person disabled by an illness or accident to regain abilities makes no sense,” said Senator Collins. “This legislation would ensure appropriate access to important outpatient rehabilitation services under the Medicare program to ensure that beneficiaries recovering from a stroke, hip fracture, or other diseases or conditions requiring extensive therapy can receive all of the services they need. In addition to improving the health and well-being of seniors, rehabilitation is also more cost effective than similar services provided in the hospital outpatient setting, which are not subject to the caps.”

Limits on outpatient rehabilitation therapy services under Medicare were first imposed in 1997 as part of the Balanced Budget Act. The decision to impose limits on these services was not based on data, quality-of-care concerns, or clinical judgment—its sole purpose was to limit spending in order to balance the federal budget. Since 1997, Congress has acted over 16 times to prevent the implementation of the therapy caps through moratoriums and an exceptions process. While these short-term actions have provided necessary relief to our seniors, a long-term solution is essential to bring permanent relief and much-needed stability for both patients and providers.

In a 2009 report issued by the Medicare Payment Advisory Committee (MEDPAC), it was estimated that the therapy cap, if enforced without an exceptions process, could negatively impact 931,000 Medicare beneficiaries. Arbitrarily capping outpatient rehabilitation therapy services would likely cause some beneficiaries to delay necessary care, force others to assume higher out-of-pocket costs, and disrupt the continuum of care for many seniors and individuals with disabilities.

The Medicare Access to Rehabilitation Services Act is supported by a broad coalition of organizations representing the interests of patients, consumers and health care providers. Similar bipartisan legislation in the House of Representatives was introduced Wednesday by Representatives Eric Paulsen (R-Minn.) and Rep. Ron Kind (D-Wis.).