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Washington, D.C. – In an effort to fix a longstanding inequality in the Medicare system, Majority Whip Roy Blunt (R-Mo.) and U.S. Reps. Phil English (R-Pa.), Ben Cardin (D-Md.) and Frank Pallone (D-N.J.) today introduced bipartisan legislation to address the cap on therapy services under Medicare before the completion of the 109th Congress. H.R. 6132, the Securing Effective and Necessary Individual Outpatient Rehabilitation Services (SENIORS) Act, would extend the current exceptions process, as created in the Deficit Reduction Act of 2005 for one year.
“The provision we included in the Deficit Reduction Act is working so far, and should be extended," said House Majority Whip Roy Blunt. "It is helping to provide more accurate information about the therapy needs of Medicare patients so that we can set up a fair system for reimbursement, not one driven by arbitrary numbers. We can address to the needs of patients while at the same time maintaining fiscal responsibility.”
“If Congress does not act this year, seniors will be left to bear the brunt of an unfair financial burden for necessary therapy services,” said English a member of the House Ways and Means Health Subcommittee. “Whether a person receives speech, occupational or physical therapy, it should be a decision made between a doctor and a patient, not by accountants monitoring a set limit. By extending the current exceptions process we will ensure seniors’ rehabilitative needs will be met without limiting care to an arbitrary price tag.”
The Balanced Budget Act (BBA) of 1997 imposed annual caps per beneficiary of $1,500 on occupational therapy and a separate combined $1,500 cap on physical therapy and speech-language pathology under Medicare Part B. Since then, Congress has acted three times to place a moratorium on the therapy caps. On January 1, 2006, a cap of $1,740 (adjusted for inflation) went into effect for these health care services. In response, Congress included a provision in the Deficit Reduction Act of 2005 (P.L. 109-171) to provide beneficiaries with a clinically based exceptions process to the financial limitation on rehabilitation services under Medicare. To date, the exceptions process has served as a mostly acceptable alternative to ensure seniors have access to all necessary services.
The SENIORS Act would extend the exceptions process for an additional year, providing the Centers for Medicare and Medicaid Services (CMS) and Congress time to establish an effective and permanent solution.
"While we need to permanently repeal the therapy caps, the exceptions process makes it possible for Medicare beneficiaries with complex medical problems to receive the services they need. There is limited time left in the 109th Congress, and I urge Congress to act now to ensure that the exceptions process continues to be available to beneficiaries through 2007," said Cardin, a member of the House Ways and Means Committee.
“Congress must act quickly to extend the exceptions process currently in place, otherwise millions of our most vulnerable seniors will be denied access to the treatment they need to live healthy and productive lives,” said Pallone, a member of the House Energy and Commerce Health Subcommittee. “At the same time, we must continue our work to repeal the therapy cap altogether. This arbitrary limit discriminates against Medicare beneficiaries who desperately need outpatient therapy.”
Blunt, English, Cardin and Pallone have introduced legislation to permanently repeal the caps on rehabilitative therapy under Medicare for the past three Congresses. This Congress, H.R. 916, the Medicare Access to Rehabilitation Services Act has gained the support of 259 members of Congress. |
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