Lawmakers propose a repeal of Medicare B therapy caps

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Lawmakers propose a repeal of Medicare B therapy caps
Lawmakers propose a repeal of Medicare B therapy caps
Lawmakers in the U.S. House and Senate recently introduced proposals that would repeal payment caps for Medicare Part B therapy patients.

Most nursing home residents are currently exempted from the caps under a sweeping exceptions process, but the lawmakers — as well as providers — are eager to see them eliminated entirely.

Beneficiaries are currently limited to $1,870 worth of services annually for speech and physical therapy combined. There is an identical limit for occupational therapy.

“Therapy caps discriminate against the very Medicare beneficiaries who are most in need of therapy services,” said Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care. “Studies have shown that patients with stroke, hip fractures, Parkinson's disease and other conditions requiring extensive rehabilitation are most likely to be affected.”

The caps were approved in 1997 but were stalled by moratoria for many years. They have been put into full effect only briefly twice, most recently from January to March 2010.

Sen. Ben Cardin (D-MD) and nine co-sponsors unveiled their bill, S. 829, on April 14. The same day, Reps. Xavier Becerra (D-CA) and Jim Gerlach (R-PA) introduced a companion bill in the House.

The current exceptions process is set to expire Dec. 31, leaving lawmakers less than eight months to come up with an alternate plan.

Morton cautioned that the bills' passage might face long odds, partly because the caps have been in the public eye for so long.

“We hear a lot of, ‘Yes, OK, I get it,'” she said of members of Congress. “We may be headed toward ‘therapy cap fatigue.'”
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