The Monday Memo
March 31, 2014 PITT DPT STUDENTS
The end of the Medicare Therapy Cap?
Today is the end of the extension of the current Medicare Therapy Cap and exceptions process. January 1, 2014 marked the start of the extension established to allow time to make adjustments to the Sustainable Growth Rate (SGR) formula and a permanent solution to the Medicare Therapy Cap. Efforts have continued to gain and strengthen support for the Medicare Access to Rehabilitation Services Act introduced February 14, 2013 that, if passed, would fully repeal the Medicare Therapy Cap. Since the first of the year, proposals have been introduced to reform the SGR, but not all of those proposals have mentioned the therapy cap.
On March 14, 2014 the House passed the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 within which is no inclusion of Medicare extender policies or a repeal of the therapy cap. Last week the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 was introduced that contains the same SGR policy as the act passed by the House but also includes Medicare extenders and provisions for a therapy cap repeal and is to be voted on early this week. Most recently, on March 27, 2014 the Protecting Access to Medicare Act of 2014 was passed by the House that would extend the therapy cap exceptions process for 12 months.
While awareness has been raised about the need for a repeal of the Medicare Therapy Cap and solutions to the issue have been proposed, the answer to whether or not Medicare beneficiaries will face limited coverage for outpatient physical therapy services is unclear. What is clear is the huge impact a hard financial cap will have on the Medicare beneficiaries who will not be able to continue necessary outpatient physical therapy because of an inability to pay for services. Sources cited in an article by Fritz et. al in 2011 reported 3.9 million individuals, or 8.5% of those with Medicare insurance, received outpatient physical therapy in 2006, and about 15% of the population who received outpatient physical therapy services were Medicare beneficiaries. The number of Medicare beneficiaries utilizing outpatient physical therapy has likely risen from that reported in 2006 and will likely continue to rise as the population ages. We can hope for a permanent solution in the form of a full repeal of the Medicare Therapy Cap; but, irrespective of the final outcome of this extension, it is our responsibility to continue to advocate for this population that is in need of our services.
Fritz, JM., Hunter, SJ., Tracy, DM., Brennan, GP. Utilization and clinical outcomes of outpatient physical therapy for medicare beneficiaries with musculoskeletal conditions. Phys Ther. 2011; 91 (3): 330-345. doi: 10.2522/ptj.20090290
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