Medicare Therapy Caps

by Howard Gerber on January 19, 2012

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Congress was in the news quite a bit in December because of the many extensions that were set to expire the first of January if they were not extended. The therapy cap provision was especially concerning for those in speech, physical, and occupational therapy positions. Fortunately, it has been extended until February. However, it could still be eliminated unless Congress makes a more permanent decision. Had the legislation not been extended there would have been a 27.4% reduction in the fee schedule and exceptions for the early $1,880 therapy cap would have been removed. Just how important is it that these measures not be removed?

Giving Needed Care

There are two considerations to the therapy cap issue in regards to patients. First, is the fee reduction for providers. If Medicare reduces the amount providers will be paid, many will simply stop accepting Medicare patients. In some areas, it may be become impossible to find services locally and would make it necessary for patients to travel considerable distances to find the care they need. It may also mean they would have to begin services with a new provider even if they have developed a relationship with their current therapist.

The second problem is the amount of services a patient can receive each year. While there is currently a cap, it can be exceeded for special circumstances. Some patients may need years of therapy if they have had a severe accident or suffered a stroke. If there is a firm limit, there would be no way for them to receive the care they desperately need with their Medicare benefits. If they have no other insurance option many of these patients will simply not get the care they need at all. For a person who is trying to learn to walk or talk again this is unthinkable.

Livable Wage

While it is obviously important that the patients who need specific care are given the quality and quantity of treatments they need and deserve, it is also important that the professionals are able to make a living giving the care. In addition to paying the therapist, other staff must also be paid such as clerks and therapy assistants. If the Medicare fees are cut and the therapy offices decide to continue seeing Medicare patients, they may have to make staffing cuts because of the fee reductions. In a time where jobs are difficult to obtain, this could be a disaster for newer therapist and the staff that supports them.

Have you contacted your Congressional representatives to let them know how you feel about these possible cuts? While the cuts have been delayed, they have not been prevented. The American Speech Language Hearing Association maintains a database of representatives if you want to talk to your representative.

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