LTC groups urge Congress to pass a therapy cap extension

Cynthia Morton

Congress should extend the therapy caps exception process for medically necessary Medicare Part B outpatient therapy services, several long-term care groups said Tuesday.

The provider groups, including American Health Care Association and the National Center for Assisted Living, the National Association for the Support of Long Term Care and the Alliance for Quality Nursing Home Care, argue that caps of $1,870 for physical therapy and speech-language pathology, and a separate $1,870 cap for occupational therapy, put undue hardship on Medicare beneficiaries.

The therapy cap exceptions process is the result of the Balanced Budget Act of 1997, when Congress put a limit on outpatient rehabilitation therapy services. Then, the Centers for Medicare & Medicaid Services implemented an exceptions process for Medicare beneficiaries with certain conditions who exceeded the cap on Part B therapy services in 2006. Congress has had to re-extend this process several times. The current extension expires Dec. 31.

“From recovering after a stroke to regaining independence after a fall, thousands of beneficiaries will hit this cap within a matter of weeks,” said Cynthia Morton, Executive Director of the NASL. Morton told McKnight's Editor James M. Berklan in October that long-term care providers must be advocates for therapy for their residents.