Therapy cap exceptions process must be extended, advocates urge

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Members of a Congressional conference committee need to authorize the longest possible exceptions extension for Medicare Part B therapy services, according to a coalition of therapy advocates.

The Therapy Cap Coalition, which is comprised of several provider, patient and professional groups, is working to lift a limit placed on rehabilitation therapy services that Congress implemented as a result of the Balanced Budget Act of 1997. The Centers for Medicare & Medicaid Services created an exceptions process to this limit for certain Part B beneficiaries in 2006, which Congress has to keep re-extending. The long-standing issue has resulted in what one expert called “therapy-cap fatigue” last year.

“Rehabilitation is time sensitive — it is critical for these beneficiaries to get the right care at the right time,” Tim Nanof, director of federal affairs at the American Occupational Therapy Association, said in a statement. “The therapy cap limits access to appropriate care and the consequences can be catastrophic for the most vulnerable beneficiaries.”
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