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Patient Advocacy Groups Press Congress to Prevent Implementation of Hard Cap on Therapy

03-Dec-2012 With less than 30 days until expiration of the policy that provides critical outpatient therapy to Medicare beneficiaries, 8 leading consumer and patient advocacy groups called on Congress today to extend the therapy cap exceptions process through 2013. These groups emphasized the devastating patient impact of the therapy cap, noting that the cap affects the most vulnerable Medicare beneficiaries.

The American Heart Association, the Arthritis Foundation, the Brain Injury Association of America, Easter Seals, the Parkinson’s Action Network, the National Multiple Sclerosis Society, the National Stroke Association and the United Spinal Association are part of the Therapy Cap Coalition which annually advocates against a hard cap on therapy from going into effect under Medicare.

Sue Nelson, Vice President of the American Heart Association said “the health of hundreds of thousands of seniors and individuals with disabilities who rely on Medicare for therapy services is in jeopardy if Congress does not act before December 31.”

Approximately 20 percent of Medicare Part B beneficiaries who receive physical therapy, occupational therapy, or speech-language pathology services exceed the cap each year. These beneficiaries often live with an illness such as Parkinson’s disease, multiple sclerosis, or stroke, or experience more than one episode of illness or injury in a twelve-month period.

Jim Baranski, Chief Executive Officer of the National Stroke Association explained, “Patients who experience the most severe strokes often need the most therapy to recover, and they will be the most impacted if this hard therapy cap policy goes into effect. Stroke survivors deserve a chance to recover to their fullest potential, and therapy services are an essential part of that recovery.”

Susan Connors, President and CEO of the Brain Injury Association of America added, “Our nation cannot balance its fiscal crisis on the backs of patients with chronic conditions or catastrophic injuries, like traumatic brain injury.”

Without Congressional action, beneficiaries in need of vital rehabilitation services will be forced to delay necessary care, assume higher out-of-pocket expenses, or forgo care altogether. “People with Parkinson’s disease need physical, occupational, and speech-language therapy to be able to perform basic functions – walking, talking, eating -- that so many of us without Parkinson’s take for granted,” said Amy Comstock Rick, CEO, Parkinson’s Action Network. “Medicare therapy caps prevent some people with Parkinson’s from receiving some of the only treatments available to maintain a meaningful quality of life.”

Congress adopted the therapy cap in 1997 as part of the Balanced Budget Act. Since that time, Congress has recognized the cap’s potential harmful effect on Medicare beneficiaries and has acted nine times to prevent implementation of a hard cap. This was first accomplished through a series of moratoria and now through a clinically based exceptions process to the therapy caps.

“The exceptions process is critical to provide adequate care to patients who suffer from injury or a chronic condition, such as arthritis, and require medically necessary care above the cap,”

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