Repeal Beneficiary Cap on Therapy Services

(03/2003)

Don't discriminate against the sickest and oldest Medicare beneficiaries.

The Medicare outpatient rehabilitation therapy cap is a beneficiary cap as a result of the Balanced Budget Act of 1997 (BBA). The $1,500 therapy cap would apply to all Medicare beneficiaries in all health care settings, except hospital outpatient departments. Most Medicare beneficiaries would never exceed the annual cap, but it would force approximately 13% of the senior citizens who need such care the most to decide between forgoing necessary care or paying 100% of the cost out-of-pocket. Beneficiaries who suffer from a stroke, or have Parkinson's disease or osteoporosis are more likely to be the type of patient needing such care. Don't make them pay because they are sicker.

Quality data is not readily available to create an alternative payment methodology.

The Centers for Medicare and Medicaid Services (CMS) and health care providers are struggling to establish some form of alternative payment methodology that focuses on meeting the health care needs of beneficiaries. It is unlikely that such a methodology will be ready for implementation any time in the foreseeable future. Without a viable alternative payment methodology, the beneficiary cap on therapy services should not be the answer. The cap should not be an option again. Take it off the table permanently.

Congress has already recognized the shortfall of beneficiary cap on therapy services.

Congress has twice imposed a moratorium on the beneficiary cap on therapy services. In 1999, Congress placed the $1,500 cap under a two-year moratorium. In addition, nearly 60 Senators and over 120 Representatives recognized the problems associated with the beneficiary cap by supporting legislation to revise the therapy caps. Then in 2000, Congress further extended the beneficiary cap moratorium by one year. Unfortunately, the cap will be back on January 1, 2003. It is time to permanently extend this moratorium. Repeal the beneficiary cap on therapy services once and for all.