Repeal Beneficiary Cap on Therapy
Don't discriminate against the sickest and oldest Medicare
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
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.