WASHINGTON -- Rep. Benjamin Cardin today introduced legislation that would allow Medicare beneficiaries to receive necessary outpatient rehabilitation services in excess of the arbitrary $1,500 limits scheduled to take effect next year. The 1997 Balanced Budget Act imposed these caps as a cost saving measure without benefit of hearings or analysis of the potential impact on patients. "This misguided policy hurts patients who require extensive rehabilitation for strokes, hip fractures, and other serious conditions," said Rep. Cardin.

    The Congressman, a senior member of the Ways and Means Committee, joined Republican Reps. Phil English (PA) and Roy Blunt (MO), and Democrat Frank Pallone (NJ) to introduce the Medicare Access to Rehabilitation Services Act of 2002.  The legislation would permit Medicare beneficiaries to receive necessary rehabilitative services based on their condition and not on financial considerations.

    The 1997 Balanced Budget Act (BBA) imposed a $1,500 cap on physical therapy and speech-language pathology services, and a separate $1,500 cap on occupational therapy services. In 1999 and again in 2000, Congress delayed implementation of the caps, but without further Congressional action this year, they will take effect on January 1, 2003.

    "Studies show that more than one in ten Medicare beneficiaries who receive outpatient rehabilitative services exceed the $1,500 cap. While many seniors can be treated successfully for less, those with more serious conditions often surpass this dollar limit. This policy forces seniors to pay out-of-pocket for the care they need," said Rep. Cardin. "Medicare should cover necessary therapy services. Providers shouldn't be forced to keep one eye on the patient and the other on a calculator."

    The BBA also mandated that HCFA (now the Centers for Medicare and Medicaid Services – CMS) recommend an alternative payment system by January 1, 2001. In addition, the 1999 Balanced Budget Reconciliation Act (BBRA) required a report on utilization patterns that was due on June 30, 2001. CMS has not yet submitted either report to Congress.