Help Support the Medicare Access to Rehabilitation Act of 2007

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Help Support the Medicare Access to Rehabilitation Act of 2007
Write your members of Congress!
The Medicare Access to Rehabilitation Services Act of 2007 (S. 450/H.R. 748) was introduced in the Senate and House of Representatives on January 31, 2007 for the 110th Congress. Due to a number of changes in the House and Senate, there will be a few new names as the chief sponsors of the legislation in both chambers of Congress.

Senators John Ensign (R-NV), Blanche Lincoln (D-AR), Ben Cardin (D-MD), and Susan Collins (R-ME) will be the chief sponsors in the Senate. In the House, Representative Xavier Beccerra (D-CA) will take the lead, and be joined by Representatives Phil English (R-PA), Mike Ross (D-AR), Chip Pickering (R-MS) and Roy Blunt (R-MO).

The bill is the same repeal approach that has been introduced in previous Congresses. The bill will require substantial grassroots action in 2007 in order for the caps to be addressed prior to December 31, 2007. The most recent legislation addressing the caps in 2006 came down to the end of the year, and took an extreme amount of effort and relentless grassroots action from AOTA, other provider and consumer groups, and members of Congress.

Under the Medicare Part B Outpatient Rehabilitation Benefit, there is an annual $1,780 cap on occupational therapy services, and a separate $1,780 cap for physical therapy and speech language pathology combined. However, in December 2006, Congress passed the Tax Relief and Health Care Act of 2006 which extended a 1-year alternative to the therapy cap that was including the Deficit Reduction Act of 2005. The alternative is an exceptions process to the cap that allows Medicare beneficiaries who reach the cap ($1780 for 2007) to apply for additional services. The 2007 alternative differs slightly from the system in place for 2006 in that all exceptions are applied for automatically and must have documentation proving medical necessity.

These caps do not affect hospital outpatient rehabilitation services. The caps were implemented as part of the Balanced Budget Act of 1997 (BBA) and are the only dollar limits on care in Medicare.

Action Needed

Congressional action is needed to change the law and eliminate the cap. Ask your Members of Congress (two U.S. Senators and one member of the U.S. House of Representatives) to take action to remove the cap on Medicare Part B outpatient occupational therapy. Specifically, ask them to sign on as cosponsors to the Medicare Access to Rehabilitation Services Act of 2007 (S. 450/H.R. 748). Their cosponsorship of this legislation will help to move ahead efforts to fully repeal this cap before December 31, 2007. Unless Congress takes action by December 31, 2007, the original therapy caps will be implemented on January 1, 2008.

AOTA Position

The caps on outpatient rehabilitation should be removed because they are arbitrary, inappropriate, and potentially harmful to the most vulnerable Medicare beneficiaries. Other ways must be found to control cost and utilization in a fiscally responsible manner. Congress must repeal the $1780 caps to protect the health and well being of our Nation's Medicare beneficiaries.

Background

The Balanced Budget Act of 1997 (BBA) [Public Law 105-33] imposed a payment limitation on outpatient rehabilitation services under Medicare Part B, to begin January 1, 1999. The limit affected providers including private practitioners, clinics, rehabilitation agencies, skilled nursing facilities and home health agencies (for services for non-homebound individuals). The BBA established a separate cap of $1500 annually per beneficiary for occupational therapy and a combined cap of $1500 annually per beneficiary for physical therapy and speech-language-hearing services.

The Balanced Budget Refinement Act of 1999 (BBRA) [Public Law 106-113] placed a two-year moratorium on application of the $1500 caps (for years 2000 and 2001). The Benefits Improvement and Protection Act of 2000 (BIPA) [Public Law 106-554] extended, by one additional year, the two-year moratorium on the application of the $1,500 caps for outpatient rehabilitation services. This affirmed that the moratorium was in place for dates of service through December 31, 2002 CMS implemented the cap on September 1, 2003. Many beneficiaries reached the cap by the time Congress was trying to pass the Medicare Modernization Act of 2003 [Public Law 108-173] in November.

The Medicare Modernization Act of 2003 included a two year moratorium on the caps that lasted until December 31, 2005. Due to procedural problems in Congress, neither chamber was able to complete the Deficit Reduction Act of 2005 that included legislation addressing the caps. However, Congress was able pass the Deficit Reduction Act of 2005 [Public Law 109-171] on February 1, 2006. The bill included a one-year alternative to the caps process to ensure that Medicare beneficiaries could access rehabilitation care. This exceptions process was in place for one year only. Most recently, Congress passed the Tax Relief and Health Care Act of 2006 [Public Law 109-432] which included a one-year extension of the therapy cap exceptions process.

The moratorium that was in place for 2000, 2001, 2002, 2004, 2005, and now 2006 will ensure that Medicare beneficiaries are able to access necessary occupational therapy, physical therapy, and speech-language pathology services regardless of the setting in which they received their care. Congress must act to assure that Medicare beneficiaries' benefits will not be reduced in the future. Congress must take action to repeal the caps prior to December 31, 2007.