Bill Seeks Repeal of Rehab Care Spending Caps
Thu Feb 28, 6:04 PM ET
By Todd Zwillich

WASHINGTON (Reuters Health) - US lawmakers introduced legislation Thursday aimed at permanently repealing limits on rehabilitation therapy that have been on the Medicare law books since 1998.


Supporters said the bill would do away with an arbitrary limit in the law that caps physical and occupational therapy spending each at $1,500 annually per patient. The limits, they said, force vulnerable Medicare patients to ration their rehab therapy care and may even repel would-be therapists from the profession because of a potential lack of reimbursement.

"This is the only cap on Medicare services," said Rep. Phil English, the bill's chief sponsor. "It's an illogical cap, seemingly picked from a hat," said English, a member of the House Ways and Means health subcommittee.

Congress enacted the caps in an effort to curb overall Medicare spending as part of the Balanced Budget Act of 1997. Patients have never actually confronted the limits because of temporary moratoria enacted by Congress every year since. The latest moratorium, passed in 2000, is set to expire in January 2003.

Sponsors want a permanent repeal of the limits for fear that they could have adverse effects on patients suffering from stroke, Parkinson's disease (news - web sites), hip fractures or other common ailments requiring rehabilitative therapy.

An October 2001 analysis conducted by the accounting firm PricewaterhouseCoopers estimated that Medicare recipients requiring physical or occupational therapy spend an average of $420 per year on the benefit. About 7.3% of all beneficiaries use enough therapy services to reach the $1,500 limit each year, after which they must pay 100% of the cost of treatment themselves, according to the study.

Repealing the caps would cost Medicare an additional $1.62 billion by 2011, according to the analysis, which was financed by the National Association for the Support of Long Term Care, an industry trade group.

Lawmakers said the caps could force disabled beneficiaries to choose between needed rehabilitation care and other expenses.

"It's time to take (the cap) out of the law once and for all," said Rep. Benjamin Cardin (D-MD), also a member of the Ways and Means Committee.

Several therapy-oriented organizations lent their support to the bill. Steven M. Levine, a physical therapist from Timonium, Maryland, said that he has seen the threat of the reimbursement caps drive qualified physical and occupational therapists away from the profession.

"We know that because of the ratcheting down of physical therapy reimbursements, people are leaving the field," said Levine, the speaker-elect of the American Physical Therapy Association's house of delegates.

Congress is set to consider several Medicare proposals this year, including a bill designed to increase physicians' reimbursement levels under the program.

"I am going to set this up as one of the primary issues for the House of Representatives to take a look at," English said.