NASL Supports Repealing the Outpatient Therapy Cap
On February 8, 2017, as part of NASL’s 2017 Winter Legislative & Regulatory Conference, NASL members met with their Members of Congress and asked them to support the bicameral legislation, the Medicare Access to Rehabilitation Services Act of 2017 (S. 253/H.R. 807). This important legislation repeals the “therapy cap” which is a harmful financial restriction on outpatient rehabilitation services needed by Medicare beneficiaries to recuperate and improve their functional abilities. Senator Ben Cardin (D-MD) has once again taken the lead to reintroduce the “therapy cap repeal” bill, along with Senators Susan Collins (R-ME), Bob Casey (D-PA) and Dean Heller (R-NV). The House companion is sponsored by Representatives Erik Paulsen (R-MN), Marsha Blackburn (R-TN), Ron Kind (D-WI) and Doris Matsui (D-CA).
Established by the Balanced Budget Act of 1997, the therapy cap is a statutory restriction (cap) on the dollar amount of rehabilitation therapy services a patient can receive under Medicare Part B in a calendar year. Under current law, beneficiaries face two therapy caps: a $1,980 cap on physical therapy (PT) and speech language pathology (SLP) services combined and a $1,980 cap on occupational therapy (OT)services.
Congress instituted a statutory exceptions process that allows patients to access medically necessary therapy above the annual spending cap. This process requires annual congressional authorization and since 2007, Congress has continuously extended the exceptions process. However, the current exceptions process expires December 31, 2017. Congress also put in place a medical review of therapy claims once they reach a $3,700 threshold in a calendar year. If Congress does not repeal the cap, the exceptions process must be extended beyond 2017 for Medicare beneficiaries to receive medically necessary therapy above the cap.
NASL supports the repeal of the therapy cap and providing for an equitable therapy review process so that Medicare beneficiaries will continue to have access to the medically necessary therapy services they need.