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Help urge Congress to "STOP THE THERAPY CAP"

11/27/06

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On January 1, 2006 a financial limitation, better known as a therapy cap, was placed on outpatient physical, occupational and speech therapy services received by part B Medicare beneficiaries. The dollar amount set for the 2006 limitation is $1,740.00 for physical and speech therapy combined and a separate $1,740.00 for occupational therapy.

Those most affected by the therapy cap are beneficiaries with debilitating illnesses such as Pakinson's Disease, congenital heart failure and stroke. In 2006 a moratorium was set to allow an exception to beneficiaries with qualifying diagnoses that fell within the guidelines. This exception allowed beneficiaries to continue receiving services with no interruption. This moratorium will expire on December 31, 2006, unless Congress takes action. If this limit is reinstated many medicare beneficiaries will be unable to receive treatment at outpatient rehabilitation facilities and will be forced to seek treatment at a hospital outpatient therapy clinic or a homecare agency if Medicare considers them to be homebound.

Overall, unless Congress passes legislation before January 1, 2007, therapy services may be reached in seven to ten visits. Medicare will not pay for any additional outpatient therapy services for the rest of the year. Many patients seek these services to gain independence and normal activities of daily living and it is almost impossible for them to benefit or show progress in such a short period.

WHAT YOU CAN DO TO HELP:

Many of us are directly involved or know someone who is involved in the care of a current or future medicare beneficiary. Therefore, it is critical that we ask our members of Congress to at least extend the therapy cap exceptions process by doing one or more of the following:

1. Call your U.S. Senators and House Representative toll-free at 1-866-346-9066 and ask your elected officials to make sure the therapy cap exceptions process is extended beyond 2006.

2. Email or write your Members of Congress using AOTA's Legislative Action Center. You do not need to be a member to use this website. You can send a pre-written email directly to your elected offical, or print one for mailing. The Legislative Action Center can be found at www.aota.org .

3. Ask your patients to help if you are currently in the medical field. You can inform them of the above toll-free number and ask them to call their Members of Congress or they can also write or send an Email.

The sooner Congress hears our voice, the greater chance there is that the exception process will be extended this year. Otherwise they will recess for 2006 and not come back into session until late January and the caps will already be back in place!

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