Don't Let the Medicare Beneficiary
Rehabilitation Therapy Cap Come Back!
Unless Congress acts, beneficiaries will, again, face
arbitrary limits on their rehabilitation therapy care.
On January 1, 2003, the Medicare outpatient beneficiary caps on
rehabilitation therapy will take effect. These $1,500
beneficiary caps on (1) speech-language pathology and physical
therapy and (2) occupational therapy care combined will
negatively impact care for our nation's seniors. The caps were
partially implemented in 1999, but Congress has since twice
placed such implementation under a moratorium until the end of
this year. It is time to repeal these beneficiary caps once and
Approximately 12-13% of beneficiaries needing therapy
care will exceed the annual caps.
Both MedPAC and independent analyses have demonstrated that
nearly 1 out of 7 of such beneficiaries would exceed the
beneficiary cap. If the cap comes back, beneficiaries may
self-ration care or be forced to forgo medically necessary care
altogether once the cap is exceeded.
The cap would negatively impact beneficiaries who
suffer from stroke or other circulatory-related ailments,
Parkinson's disease and musculoskeletal disorders.
One analysis conducted in 1999 on the impact of the therapy cap
during the first 2 months (based on actual Medicare claims)
illustrated the following:
- Of those who exceeded the combined $1,500 cap for
speech-language pathology and physicial
therapy, 43% were beneficiaries who suffered from both stroke- and
heart-related circulatory ailments and 28% were those who had
osteoarthritis and related musculoskeletal disorders.
- Of those who exceeded the $1,500 cap for
occupational therapy, 46% were beneficiaries who suffered from stroke-related
ailments and 23% were those who had osteoarthritis and related
It will be the older and more vulnerable beneficiaries
who will be most impacted by the therapy cap.
As beneficiaries continue to age and encounter multiple health
problems, they are more likely to be the ones to exceed the