Medicare Therapy Caps Sneak Up On Seniors

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http://consumeraffairs.com/news03/med_cap.html Medicare Therapy Caps Sneak Up On

Seniors

April 14, 2003

Medicare beneficiaries face new caps on payments for physical, speech and

occupational therapies. According to the Centers for Medicare & Medicaid

Services (CMS), Medicare will implement a $1,590 annual limit on physical and

speech therapy, and a separate $1,590 annual limit for occupational therapy,

effective July 1.

 

The new caps would affect up to 13 percent of all seniors.

 

Seniors groups are balatedly protesting the change, which slipped under the

political radar as attention was focused on the fight in Congress over a

Medicare prescription drug benefit. CMS hasn't notified beneficiaries about the

limits and possibly might contact in advance only those who already are therapy

patients.

 

" The Alliance for Retired Americans is outraged that CMS would seek to

drastically limit important rehabilitative services required to keep seniors

healthy and improve the quality of their lives, " says George J. Koupias,

President, who pledged that " the Alliance and its allies will fight to rescind

these caps. "

 

The National Committee to Preserve Social Security and Medicare sees the

rehabilitative therapy cap as being " detrimental to seniors, and we're working

hard to repeal it, " said Sharon Brigner, the senior health policy analyst for

the Washington-based lobbying group. " Seniors are not going to have access to

important services that will keep them living healthy and in their communities. "

 

Although the effect is being felt only now, the cap actually was passed under

the 1997 Balanced Budget Act. It reflected efforts by Congress and

then-President Bill Clinton to slow runaway home health care and ancillary

service costs being billed to Medicare.

 

In 1999, Congress passed a moratorium that kept the rehabilitative therapy cap

from being activated, then gave that moratorium a two-year extension in 2000.

But this year, lawmakers so far have taken no action, although there is

legislation in the House and Senate to eliminate therapy caps.

 

The cap doesn't apply to therapies received in hospital outpatient centers. But

there are fewer of those than stand-alone centers, which could mean that

patients would have to wait to be seen. Some nursing home residents might have

to be sent to a hospital for the treatments they now get from therapists at the

home if they want Medicare to pay for it.

 

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