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Thread: A $1900 MEDICARE cap on therapy services will go into effect January 1, 2013

  1. #1
    Senior Member NW-Will's Avatar
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    A $1900 MEDICARE cap on therapy services will go into effect January 1, 2013

    sorry if this has already been posted.
    There is a link on the bottom to automatically contact YOUR congressperson and Senators. It's so easy.

    A $1900 cap on therapy services will go into effect January 1, 2013 unless we act now to extend the exceptions process!

    The cap places arbitrary limits on access to medically necessary rehabilitation services for Medicare beneficiaries. For 2012 the level of the therapy cap is $1880 for occupational therapy and a separate cap of $1880 for physical therapy and speech-language-pathology services combined. Although an exceptions process is in place for 2012 the caps will return on January 1, 2013 unless Congress takes action.

    Take action to help protect beneficiary access to critical and medically necessary therapy services.
    http://www.capwiz.com/actioncenter/i...ertid=62208501

  2. #2
    Quote Originally Posted by NW-Will View Post
    sorry if this has already been posted.
    There is a link on the bottom to automatically contact YOUR congressperson and Senators. It's so easy.



    http://www.capwiz.com/actioncenter/i...ertid=62208501
    The first of many money saving ideas from out congressmen and senators in DC. Stay tuned..............

  3. #3
    $1900.00; outrageous. Just signed and sent my email urging local reps to do the right thing. Thanks for posting the link.

  4. #4
    Thanks for posting this.

    I sent my email to my senators/reps. Please everyone, click on the link and send an email.

  5. #5
    Senior Member willingtocope's Avatar
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    Hold on. I don't have time to go looking for it right now, but there's a story around here somewhere stating exactly the opposite.

    Medicare...and, as a result, private insurance...is scheduled to remove the caps on rehabilitating services. They're doing away with idea of "plateauing" (sp?), realizing that continued therapy is required to prevent regression.

  6. #6
    Quote Originally Posted by willingtocope View Post
    Hold on. I don't have time to go looking for it right now, but there's a story around here somewhere stating exactly the opposite.

    Medicare...and, as a result, private insurance...is scheduled to remove the caps on rehabilitating services. They're doing away with idea of "plateauing" (sp?), realizing that continued therapy is required to prevent regression.
    I believe that was a lawsuit the administration lost where they "denied" therapy to maintain you. I don't recall it addressing the limits on $ or visits. I may have missed that detail though.

  7. #7
    Yes, it is a little confusing.

    The lawsuit settlement says that you cannot refuse Medicare coverage of PT/OT for maintenance of function. In the past it was only covered if you were making progress.

    The caps is something completely separate, that was not addressed in this lawsuit.

    In theory, you can over-ride the caps if the docs/therapists submit documentation that you still require therapy. This ability to over-ride the cap will expire if Congress doesn't add the waiver. This happens every year it seems.
    Last edited by hlh; 12-04-2012 at 04:30 AM.

  8. #8
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    Yes, the CAP is there. It is $1800 for '12. That is the "standard" amount. You can get your provider/doctor tp provide Medicare with documentation as to why you need approval to go beyond this anmount. I have not done this, but it can be done. $1800 and $1900 are NOT therapy. Probably would not even call it "Exercise."

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