By Alli Hatcher, Andrea Guzek, & Hanna Love
Summary of issue: Every day someone is in an accident or sustains an injury that requires them to need speech-language, occupational, and/or physical therapy services. Many of these individuals are insured by Medicare. Imagine if you had a loved one who received Medicare and required any of these services after an accident or a traumatic event. Now imagine they were unable to receive the amount of services they needed due to a monetary cap on these services. Unfortunately, this could be the reality if we do not take action. In 1997 the Balanced Budget Act placed a cap on rehabilitation services for speech-language pathology, occupational, and physical therapy services for individuals receiving Medicare. The cap is $1,980 for speech and physical therapy services combined and $1,980 for occupational therapy. This cap is without regard to individual need or medical necessity. Since the bill was enacted, the catastrophic consequences of the cap have been realized and a moratorium of the cap has been implemented. This moratorium has to be revisited and advocated for every year to ensure that it does not go into effect again. In the past when the cap did go into effect it had a detrimental effect on jobs for the professionals who provide these services and the individuals who require the services to regain function necessary for quality of life. This legislation would repeal the Medicare outpatient therapy cap and ensure patients who use Medicare will continue to have access to medically-necessary speech-language pathology, occupational therapy and physical therapy services.
Why legislation is important: This year marks the 20th anniversary since the Medicare outpatient therapy cap has been enacted. Since this implementation, there have been several temporary moratoriums, or exceptions made to the act. The fact that this exception process must be made yearly causes uncertainty and unease for the therapy providers as well as the patients. Medicare recipients who suffer from stroke, traumatic brain injury, Parkinson’s disease, Alzheimer’s, among others, risk the chance of being denied services or being forced to pay out of pocket in order to receive services to help them communicate, move, or perform activities of daily life effectively. The solution is to repeal the Medicare outpatient therapy cap; with this repeal clients and their providers would be rid of the uncertainty of care and this would ensure high-quality, ongoing treatment for Medicare recipients.
What you can do to advocate: We can take action by reaching out to Congress and encouraging them to support the Medicare Access to Rehabilitation Services Act of 2017 (S. 253/H.R. 807). If our House member and/or Senator is not a current co-sponsor, we can contact them and encourage them to sign the bill as soon as possible. We can also educate ourselves and our peers on the issue. We can post about this issue on social media. We can contact physical therapy and occupational therapy organizations, as well as different NSSLHA chapters, to ensure they are actively advocating for and supporting the issue.