Therapy cap would jeopardize seniors with Parkinson’s, stroke

A cadre of healthcare groups petitioned Congress this week to extend the therapy cap exceptions through 2013. The Therapy Cap Coalition, which includes the American Heart Association, the National Stroke Association, the Parkinson’s Action Network and the Arthritis Foundation, argued that enacting the hard cap on therapy coverage under Medicare will have devastating effects on the care and quality of life for thousands of seniors and others with debilitating diseases.

Those who live with the effects of a stroke, Parkinson’s disease or a traumatic brain injury will be hardest hit by the hard cap, since their conditions often require daily occupational and physical therapy to maintain activities of daily living and quality of life, noted the coalition leaders.

The current cap for those who do not receive an exception is $1,880 for occupational therapy and $1,880 for physical and speech therapy combined, noted Amy Melnick, vice president of advocacy at the Arthritis Foundation in a statement issued Monday by The American Health Care Association. Approximately 20 percent of Medicare recipients who need physical, occupational or speech therapy will exceed the cap each year.

Placing a hard cap on therapy for Medicare beneficiaries was made law in 1997, as part of the Balanced Budget Act. However, Congress has enacted extensions to delay the implementation of a hard cap nine times since then.

If Congress chooses not to extend the exceptions, the therapy cap will begin in January.

Topics: Accountable Care Organizations (ACOs) , Advocacy , Executive Leadership , Medicare/Medicaid , Regulatory Compliance