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by Reed Franklin
If Congress doesn't act by Dec. 31, Medicare beneficiaries will again face government-imposed limits in 2006 on critical outpatient therapy services by speech-language pathologists, physical therapists, and occupational therapists. ASHA has been working closely since January with key congressional committees and provider groups to develop an alternative to the therapy caps that meets the fiscal constraints of the Medicare program.
A grassroots campaign is underway to urge Congress to take action on the caps in the coming weeks and prevent millions of Americans from losing needed therapy services. Contact your members of Congress and warn them that they have to pass Medicare legislation this year to prevent a $1,750 therapy cap from being implemented on Jan. 1, 2006.
Congress passed legislation mandating Medicare outpatient therapy caps—often referred to as the $1,500 caps, although they are indexed for inflation and now are slightly higher—as part of the Balanced Budget Act of 1997. The caps were implemented in 1999, and many ASHA members will recall the negative impact on Medicare patients and clients, as well as providers. Speech-language pathologists felt the impact keenly, since the $1,500 cap for speech-language pathology services was shared with physical therapy.
Grassroots action and vigorous lobbying in 1999 swayed Congress to lift the caps for a two-year moratorium period. The following year, ASHA again convinced Congress to extend the moratorium by an additional year, sidelining the caps until 2003.
Continued pressure was needed to keep the caps at bay. In 2003, in addition to lobbying, ASHA used legal means to try to block the caps' implementation, and took the federal government to court. The lawsuit was largely successful, and Congress imposed another two-year moratorium, which delayed the implementation of the caps until 2006.
Address Caps Now
In collaboration with other provider groups, ASHA is urging Congress to address the caps before they are implemented, and adopt a permanent solution so that patients and providers are not constantly worried about arbitrary limits being placed on services.
"We hope that Congress will address the caps, but we can't take anything for granted. It is critical that all ASHA members weigh in with their elected officials in Congress," said Kate Gottfred, ASHA vice president for governmental and social policies.
"Grassroots advocacy has been a key component in our previous successes on the caps. Our elected officials need to hear from ASHA members," she said. "We've got a good chance at victory here, but we've got to work together."
For more information about the legislative efforts to repeal the caps, contact Reed Franklin by phone at 800-498-2071, ext. 4473, or by e-mail at rfranklin@asha.org.
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