By Martha Dunkelberger, Ph.D. CCC-SLP, University of Houston
The current House Tax Bill includes increases in taxes on graduate students by more than 200%. This is because the bill as it stands now will tax the tuition waivers that graduate students are awarded as part of their employment package. In most cases, those tuition waivers are roughly double or higher value as the stipend that they already pay taxes on. In other words, they're going to get $100 in a paycheck, but pay taxes on $300.
If you're a speech-language pathologist or audiologist, that's going to affect our profession drastically since there's already a shortage of PhD level people in our fields. Academic programs will suffer first, but the practice areas will follow shortly thereafter with more severe shortages of well-qualified staff.
By Craig Coleman, M.A., CCC-SLP, BCS-F
In the summer of 1999, I was a first-year graduate student at the University of Pittsburgh. I was eager to enter the field, and excited to take a course in Professional Issues in Speech-Language Pathology. We had many guest speakers who talked about their experiences in the field. They were all very engaging and held my interest in learning more about the field. They also scared me to death! What I didn't know at that time was that a law had recently been passed that placed a $1500 cap on Medicare services for speech-language pathology.
Many of the speakers talked about how this cap had eliminated jobs in their work setting and the future of the profession uncertain, at least if you wanted to work with adults. As someone who was much more interested in the pediatric population, I had two thoughts: 1.) Whew. I will still be able to get a job. I feel bad for my classmates who want to work with adults. 2.) Wait, those SLPs who worked with adults and lost their jobs might now work with pediatrics and take my future job!
Fortunately, every year since 1999, Congress has passed an exemption on the cap, and it has not been in place since. Not coincidentally, I have had a job since then as well.
Back in 1999, students were encouraged to be active in professional issues if they wanted to be--it was encouraged, but not mandatory. Times have changed. Professional advocacy is now even in the ASHA Scope of Practice. If the field is going to thrive, we have to be active.
I created this website to give my students an opportunity (nah, really an obligation) to advocate for the profession by writing blog posts about important issues, contacting legislators, and contacting NSSLHA chapters from other universities to engage them in the advocacy project as well. They have done an amazing job, but now we need your help. We need students and professionals to write for the blog to share your stories of advocacy. What do you need? What has worked for you? What issues are important to you? How can you have the resources you need to be successful? If enough of us engage in this discussion, this can be a great resource to refer to when discussing issues with legislators, insurance companies, and other stakeholders. We need you to write for us! Send us your posts that you want to share and we will publish them here! Here is what you can do:
1. Read the Blog regularly to stay informed on important issues.
2. Write about issues that are important to you and how we can help. Send your submissions to firstname.lastname@example.org and we will publish them!
3. Share the website (www.slpadvocacy.com) with others and encourage them to get involved.
Thank you for reading and being engaged!
By Samantha Gregory, Leah Gibson, & Tayler Dye
The American Speech-Language and Hearing Association’s (ASHA) “Restore Graduate Student Loan Benefits” legislative brief advocates for graduate students to be eligible for subsidized loans. These types of loans do not accrue interest for the borrower to pay back. Graduate students should be eligible for subsidized loans because graduate students are independents who would qualify for, and benefit from, these loans. The academic responsibilities of full-time graduate education does not often allow for the time commitment of a full-time job, which is needed to pay for tuition and living costs.
ASHA’s “Reject Student Aid and Loan Forgiveness Changes” legislative brief advocates for the rejection of the 2018 education budget, because it does not include funding for the Public Service Loan Forgiveness (PSLF) program, and is reducing the number of income-driven loan repayment plan options from five to one. PSLF forgives student debt after 10-years of working in a public service setting combined with 120 consecutive loan payments. Eliminating the PSLF program will remove incentive for speech-language pathologists (SLPs) to work in schools and in at-risk school systems. There is currently a shortage of school-based SLPs, and removing an incentive to work in these locations will cause more professionals to take jobs in other, higher-paying areas like hospitals, long-term care, and private practice. PSLF does not forgive loans immediately, but after 120 consecutive payments. This means that many individuals are in fact paying back a large amount of their loans. Any interest that has been accrued may remain, but the federal government that gives out the loans is still being repaid large amounts of the original loan. The cost of PSLF is not as high as the long-term negative consequences of eliminating it.
Income-driven repayment plans allow for flexibility of payments. Reducing options will decrease the likelihood that individuals will be able to keep their monthly payments manageable, and increase the likelihood of defaulting. The combination of unsubsidized loans, elimination of PSLF, and reducing the flexibility of income-driven repayment plans, will inevitably put more strain and debt on graduate students pursuing professional degrees and careers. This may result in the discouragement of students to enter into graduate programs, and, in the long-term, reduce the number of professionals providing services and the amount of loan repayment.
Graduate Student Loans and Student Aid and Forgiveness Changes can be best advocated for by writing letters to the members of Congress who represent the writer. Other avenues for contacting members of Congress are phone calls and emails. Below readers will find a script from which individuals can read:
“I am a constituent in your federal district and I am calling to advocate for Subsidized Graduate Student Loans and for a rejection of the 2018 education budget proposal. The budget currently does not allow funds for Public Service Loan Forgiveness and reduces the number of income-driven repayment plans from five to one. I study/work in the field of Speech-Language Pathology and Audiology and believe that these issues have a direct impact on the trajectory of my education and professional career. According to the American Speech-Language and Hearing Association:
Both audiologists and speech-language pathologists require a post-graduate degree in order to be licensed in most states. Eliminating eligibility for graduate students to obtain federal loans has significantly increased the cost of borrowing, and resulted in negative impact on students who wish to pursue a graduate degree in a variety of fields, including audiology and speech-language pathology. (Graduate Student Loans)
Demand for both audiology and speech-language pathology professionals is expected to increase in the future. An additional 4,300 audiologists will be needed to fill the demand between 2012 and 2022 - a 19% increase in job openings. Speech-language pathology ranked 13th out of the 20 large-growth occupations. (Student Aid and Loan Forgiveness Changes)
“Public Service Loan Forgiveness incentivizes SLPs to work in schools and at-risk school systems. Removing the incentive will cause more SLPs to take higher paying jobs in the medical setting, further aggravating the existing obstacle of lack of SLPs in schools across the nation. Reducing repayment plans will increase the likelihood of default. Finally, PSLF is only applicable after 120 consecutive loan payments, by which time most students are paying only accrued interest or have a small amount of the original loan left to be forgiven. The federal government is receiving most of the loan in repayments. Therefore, eliminating PSLF and repayment options will create relatively fewer savings at the cost of continued and worsening obstacles for students and debt.”
Our plan is to distribute information about the discussed legislative briefs and provide scripts for contacting legislators. Your Legislators can be located at www.govtrack.us/congress/members.
American Speech-Language-Hearing Association. (2017). Index of key issues: Graduate student loans. Retrieved from: https://takeaction.asha.org/asha/Index
American Speech-Language-Hearing Association. (2017). Index of key issues: Student aid and loan forgiveness changes. Retrieved from: https://takeaction.asha.org/asha/Index
By Courtney Harrison, Cat Carpinelli, & Caroline Eckels
The treatment of any communication disorder is a dynamic process that requires levels of assessment paired with clinical expertise, evidence based research, and patient preferences.
Human beings are, by nature, unique which means that each individual with a communication disorder will require specific, individualized treatment. Speech-language pathologists (SLPs) work under a broad scope of practice, and are licensed to treat a variety of communication disorders. An Evidence-Based Practice (EBP) approach is necessary in order to uphold both ethical and effective treatment techniques for those whose needs SLPs and other health professionals serve. Autism Spectrum Disorder (ASD) is perhaps the most dynamic disorder with which those in the health professions field may be presented, as it is a spectrum disorder that may present with any number of classifying characteristics, including: impaired social skills, difficulty with speech or other forms of communication, and repetitive behaviors (Autism Speaks, 2017). Dr. Stephen Shore, an Adelphi University professor who has autism himself, once said, “if you’ve met one person with autism, you’ve met one person with autism” (What is Autism, 2017). This is a popular quote in the ASD community because in one sentence it highlights the importance of understanding that ASD is not a fixed disorder, and to classify or predict the needs of someone based solely on their diagnosis would be unfair, unethical, and ineffective. Individuals with ASD often struggle with social communication, can exhibit language problems, and may have restricted and repetitive patterns of behavior or interests (ASHA, 2017).
Understanding the varying differences among each individual with ASD is why it is important to understand the need for variability in treatment approaches. The treatment of ASD is an inter-professional task that cannot be limited to one field. Those with ASD require, and are entitled to, a dynamic set of services that meet the needs of their dynamic diagnosis. Applied Behavioral Analysis (ABA) is a popular treatment technique that is used in the treatment of ASD. Legislation has been proposed in some states that would limit individuals with ASD to receive only ABA, as it would not fund any other type of therapy (Key Issues, 2017). While ABA can be an appropriate approach, it is not the only appropriate approach. It is the responsibility of those in the interprofessional fields that treat ASD to ensure future legislation will not limit the services provided to these individuals, and that interprofessional encroachment does not occur. Ethically, it is imperative that those with ASD receive services from individuals who are trained to administer these therapy techniques. An ABA therapist does not have the same scope of practice as a speech-language pathologist, and visa versa. These individuals require many other types of therapy to help them successfully communicate and be an active member of society. Funding should cover all treatments that the individual shows a specific need for. ABA is not a coverall treatment for this highly variable disorder.
For a deeper understanding of this specific treatment, the American Speech-Language-Hearing Association (ASHA) defines ABA as the intervention and evaluation drawn from the discipline of behavior analysis that allows one to understand the reasons that certain behaviors may occur (ASHA, 2017). ABA uses many techniques that target the increase of useful, positive, and meaningful behavior and the decrease of negative behavior that may cause harm or impede learning (Applied Behavior Analysis, 2012). ABA techniques encourage basic skills such as conversing and understanding another’s perspective, listening and imitating, looking to gain attention, and reading and writing skills (Applied Behavior Analysis, 2012). Individuals with ASD may lack such skills, which is why ABA treatment is recognized as a beneficial treatment for those on the spectrum. Much of the instructions in ABA are highly geared toward speech and language acquisition which is where a speech language pathologist is most beneficial to have as a part of an interdisciplinary team.
It is both impossible and unnecessary to deny that ABA is a beneficial therapy approach for children with ASD. That being said, just as no two children with ASD are alike, no two therapy approaches should be identical, but rather should be individualized to fit the specific needs of each child. Therefore, ABA alone is typically not sufficient for treating children with ASD. A multidisciplinary approach is usually pertinent, and may include components of ABA coupled with other therapy options (ASHA, 2017). While there are a variety of different treatments for ASD available, perhaps the most significant is therapy provided by a speech-language pathologist (SLP). SLPs are trained and certified to address a variety of communicative needs for children with ASD including, but not limited to, social and pragmatic use of language, writing, literacy, executive functioning, and play. Additionally, SLPs can use Augmentative and Alternative Communication (AAC) with children with ASD who are nonverbal or have limited language and can modify them to meet the needs of the individual. SLPs are also trained to help children with ASD who have food aversion or textural issues (ASHA, 2017). They can be trained to administer a variety of accepted ASD treatments as well. This includes the following: PRT, Verbal Behavior, ESDM, Floortime (DIR), RDI, TEACCH, and SCERTS. SLPs are not the only professionals that should be considered when treating children with autism (Autism Speaks, 2017). Physical Therapists, Occupational Therapists, psychologists, and special education teachers may all play a role in treating a child with ASD (ASHA, 2017). Each child must be evaluated for their specific needs and deficits, and an intervention plan that may include any of the aforementioned elements should be put into place.
As of right now, there is no specific legislation in place that limits ABA as the only treatment technique for those with ASD, but that may change in the near future as individual states are leaning toward only funding ABA(Applied Behavioral Analysis, 2012). Again, it is the responsibility of those in the health professions field to ensure that ASD is treated in the same regard as other communication, neurological, and general disorders. The treatment should be chosen based on the individual’s needs and in most cases, children with ASD are dependant on more than one type of therapy. Individuals should not be denied access to effective or appropriate therapy techniques because they are not funded in the same way that ABA is funded.
American Speech-Language-Hearing Association [ASHA]. (2017). Applied Behavior Analysis
and Communication Services. Retrieved from www.asha.org/NJC/Applied-Behavior-Analysis-and-Communication-services/.
American Speech-Language-Hearing Association [ASHA]. (2017). Autism (Autism Spectrum
Disorder). Retrieved from https://www.asha.org/public/speech/disorders/Autism/#two
American Speech-Language Hearing Association [ASHA]. (2017). “Index of Key Issues.” Key Issues
Index. Retrieved from https://takeaction.asha.org/asha/Index
Applied Behavior Analysis (ABA). (2012, July 24). Retrieved October 21, 2017, from
Autism Speaks. (2017). Treatments & Therapies. Retrieved from
“What Is Autism?” What Is Autism - Understanding the Autism Spectrum. (2017).
Retrieved October 22, 2017 from
By: Amber Govey, Karli Kubincanek, & Cassidy Martin
It is estimated that about 131 of every 1,000 school-age children have some degree of hearing loss that can potentially affect communication, learning, literacy, psychosocial development, and academic achievement (ASHA Take Action, n.d.). Therefore, the Individuals with Disabilities Education Act (IDEA) needs strengthened to enforce and clarify the need for educational audiologists for the deaf or hard of hearing children in the school system.
What is the issue? Why is it important?
The role of educational audiologists is to interact directly with parents, teachers, nurses, speech-language pathologists, and other related service professionals to form an educational team, which serves students under IDEA or 504 plans. Specifically, they provide education related to the effects of hearing loss, auditory processing deficits, and ideal listening environment; therefore, it is important that children with hearing loss are consistently provided with optimal, language rich environments (Educational Audiology Association, 2009).
Educational and private audiologists work together to ensure that students are receiving the highest quality hearing technology and support services within a school setting. Hearing loss prevention programs, hearing screening programs and classroom acoustics are other areas within the scope of practice of an educational audiologist. Providing consultation to the school nurse on screening programs, the speech-language pathologist for communication strategies, or a classroom teacher regarding acquisition of the phonemic information critical to literacy -- are all part of the role of the educational audiologist within a school system (Educational Audiology Association, 2009). However, this type of service is not readily available in most school systems under current laws. As a result, many children are not receiving proper audiological services that best suit their needs.
To address this concern and strengthen IDEA, contacting legislators and federal Department of Education is essential. Since IDEA is a federal law, a bill would need to be drafted in order to clarify the role of educational audiologists in the schools. Therefore, to take action, our primary goal is to advocate for this concern and spread awareness to not only the general public, but to those who are able to get a bill introduced. To begin, we will construct a letter to send to the senate and house committee members to bring their attention to the issue at hand. Within the letter we will be asking that a bill be drafted by a member who shows interest in the topic we are addressing. We will also create a Facebook post regarding the issue to bring awareness to the topic. The Facebook post will include statistics, the link to the ASHA Take Action Issue Brief, and a pre-constructed letter addressed to the legislation and federal department of education, with instructions for how to submit the letter.
What can you do?
As you can see, it is of high importance that children with hearing loss are provided with the proper hearing environment in order to learn, develop, and grow to be successful students. To help spread the word, here are some ways in which you can advocate:
1. Educate yourselves and others on the topic.
2. Share the Facebook post to help spread awareness.
3. Submit the pre-constructed letter to legislation and federal department of education in order to address the issue.
Educational Audiology Association. (2009). School-based audiology advocacy series school-based audiology services. Retrieved from
ASHA Take Action. (n.d.). Children with hearing loss. Retrieved from https://takeaction.asha.org/asha/DHHC
By Caitlyn Tucker & Haley Stang
Summary of the issue:
The Affordable Care Act (ACA) requires non-grand-fathered health plans from insurance companies offered in individual and small group markets to offer benefits for 10 essential health benefits (EHB). Habilitation and rehabilitation services and devices are one of the essential health benefits included in the ACA. Speech and language services are considered to be a habilitative and rehabilitative service. Without EHB, speech-language pathologists would be unable to assist many clients with speech, language, swallowing, or cognitive difficulties.
Why is this important?
It is important for these services to be covered by insurance because treatment may prevent further negative consequences for people with communication disorders. Speech and language services aid in the opportunity for children and adults to have the ability to communicate across various settings. Progress in communication not only aids in education and vocational opportunities, but it increases quality of life among individuals who are diagnosed with communication disorders. Children who are receiving speech and language services may benefit from being able to have a better understanding of the curriculum. Speech-language pathologists provide treatment for children with literacy disorders so they can function in a classroom and prepare for their future. Elementary and high school education is crucial to higher education and eventually finding a job. Without speech and language services being funded by insurance companies, we may see a decrease in young adults attending college and becoming successful members of society. Speech and language services are essential for all age populations of the United States. If these services weren’t compensated by insurance companies, the majority of individuals who have suffered from a stroke or disease of the CNS would be at risk for negative impacts in their quality of life based on communication disorders that may follow their medical conditions. For example, a client that has vocal nodules may be able to rehabilitate their voice with speech therapy. However, the client may have to undergo surgery if they are unable to get speech and language services.
As of now, habilitation mandates are projected to cost less than 1% of the total premium costs. In addition to the benefits listed above, more money will be saved in the future by retaining EHB because more people will receive the services they need by speech-language pathologists. However, the United States will have a larger amount of debt if insurance companies do not provide coverage for habilitative and rehabilitative services because more people may attend the hospitals or doctor’s offices rather than receiving these services. As a result, medical bills from hospital and doctor’s visits will increase which will contribute to more debt.
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.
By Meredith Brown, Katie Kramer, & Alison Wilkinson
Medicaid is a program that helps lower income families afford health care. The Individuals with Disabilities Education Act (IDEA), is a law promising services to children with disabilities in the school systems throughout the United States.
Unfortunately, the government wants to implement block grants on Medicaid for students with special needs, which will prevent them from getting every service they may need. The money would go to each of the students’ needs, but always goes toward the most significant concerns first. These students have multiple needs in some cases and may also have issues with attention and movement, which would also be categorized as more urgent. As such, there may be little to no funding left for speech services. This will prevent special needs students from getting all of the services they need, including speech therapy, which prevents them from reaching their full potential. Having various forms of therapy available to them will lead to students becoming more well rounded.
If these students do not receive these services in the school, they may not receive them at all. Students who are covered by Medicaid are usually from low income families, and blocking the funding for these students’ services would be unethical. The families want the best for their child, but may not have the financial stability to receive services somewhere outside of the school system. It is unjust that these students and families are forced to prioritize certain issues over others when they should be able to help their child in every aspect of their disorder(s).
Special needs programs in the schools already receive static funding through IDEA, which already limits the amount of money they receive. Because of this, schools rely on Medicaid to receive more funding for further services. Districts can be reimbursed for tests or screening that they give, but if Medicaid is providing a block of funding, this will prevent the schools from being reimbursed. If the schools do not get reimbursed for these activities, this may prevent them from providing further services when needed. Schools will have to pay out of pocket for the remaining services that their students need. This means that districts will have to redirect funds from other sources to provide services to those students under IDEA.
We want to oppose the block grant or the per capita that Medicaid puts on IDEA students and their services. As inspiring speech-language pathologists, it is important that we support programs that will provide the most assistance to those we serve. These students deserve the same treatment that other students receive, and they should not have less support because the of lack of money the government is willing to give.
By Mallory Newsome, Savannah Rice, & Samantha Mason
What are we advocating for?
We are asking that our congressmen reject proposals by the Trump Administration that would make graduate or doctoral level education more expensive and difficult to pay back. This includes supporting legislation that would allow graduate and doctoral level students to take out federal direct unsubsidized loans, as well as rejecting proposals that eradicate the Public Service Loan Forgiveness program.
What does that mean?
To become a licensed speech-language pathologist or audiologist, education beyond the undergraduate level is required. An additional 2-4 years of education is required, depending on the chose field. Advanced education increases the amount of student loans to be paid back after graduation.
Advocacy for the prevention of changes to the Public Service Loan Forgiveness program is needed. It would also be beneficial towards students in the future to restore graduate student loan benefits by allowing graduate and doctoral level students to take out direct federal subsidized loans instead of forcing them to take unsubsidized loans with a much higher interest rate. Many students have been negatively impacted from graduate loans, especially in the fields of speech-language pathology and audiology.
Within President Trump’s budget request for the 2018 fiscal year, many affordable plans for graduate students to repay college debt would be eradicated. These changes made to the budget would eliminate the Public Service Loan Forgiveness program, established by George W. Bush in 2007. In this program, loan forgiveness depends on work and payment stipulations.
Ten years of providing treatment in a non-profit public setting and completing 120 consecutive payments on the loans will be exchanged for forgiveness of the remainder of the loans. Instead, these changes would require graduate students to adopt repayment plans much like traditional mortgage loan systems. The repayment system would extend from 10 years to 30 years. If these changes are passed, all graduate students with loans originating post October 1, 2017 will no longer be eligible for the Public Service Loan Forgiveness program. It is important to reject the proposals by the Trump Administration to allow graduate education to be easier to pay back. If the Public Service Loan Forgiveness program is taken away, students would not have the ability for their loans to be forgiven after 10 years. Graduate or doctoral students deserve the opportunity to be employed through a non-profit organization for 10 years while paying 120 consecutive payments on student debt before loans are forgiven.
Why is this important?
Both speech-language pathology and audiology are expected to increase in demand in the coming years, so the number of students taking out graduate level loans will also increase. Audiology job openings are expected to increase by 34% and speech-language pathology job openings are expected to increase by 19%. In addition, as a professional level occupation, speech-language pathology is ranked 13th out of the 20 large-growth occupations that require a master’s, doctoral or professional degree to enter the field. People pursuing higher levels of education do not deserve to be punished for choosing a career path that requires a master’s degree, or higher, at job entry. Speech-language pathologists and audiologists pursue these careers to make a difference in people’s lives, not to have to pay back high sums of interest, as well as large amounts of loans. This can be prevented by making individuals seeking professional level education eligible for graduate student loan benefits, as well as keeping the Public Service Loan Forgiveness programs available for use.
What can you do to help?
To prevent punishing individuals for seeking professional level education, contact your state congressmen to advocate for the rejection of the Trump Administration’s 2018 budget request, which will eradicate the Public Service Loan Forgiveness program, in turn inhibiting individuals from getting their loans forgiven after October 1st, 2017. It would also benefit individuals pursuing professional level education to advocate for your state congressmen to support the restoration of graduate student loan benefits.
By Kayla Caudle, Natalie Saber, & McKayla Burgess
For the past 20 years, due to wording in the Medicare portion of the Social Security Act, a Medicare cap has existed in the law. This cap would place a limit on how much an individual can be reimbursed for therapy each year. The Medicare cap, however, has not been implemented since 1999 thanks to Congress making exemptions and placing moratoria on the cap. The Medicare therapy cap is now a real danger, however, because the time limit on those exemptions have run out. For 2017, the cap is $1,980 for speech-language pathology and physical therapy services, combined. Even if medical professionals deem the services necessary, the therapy cap is still in place. Ultimately, this cap could potentially prevent those who desperately need therapy from receiving services. For example, individuals who have suffered a life-altering diagnosis, such as stroke, Alzheimer’s, or Parkinson’s disease may be denied therapy, or forced to pay out of pocket for services to regain their ability to communicate. Up until now, Congress has stopped this therapy cap by implementing temporary moratoria and exceptions processes. In April of 2015, Congress passed the Medicare Access and Chip Reauthorization Act, which President Obama later signed into law. This allowed exceptions to the therapy caps for medically necessary services, and individuals who required therapy services were able to receive it. This was not a permanent fix, but is in effect until December 31st, 2017. The Medicare Access to Rehabilitation Services Act of 2017 looks to permanently repeal the therapy cap by amending the Social Security Act. Congress passing this act would mean that individuals who need therapy services would have access to them. Since the cap has been stopped every year up until now, repealing this portion of the Social Security Cap would not come at any additional cost to the American people, but it would ensure them the services they need.
In 1972 a bill was passed in congress to include outpatient therapy services in Medicare coverage. Fast forward to 1997 when congress passed the Balanced Budget Act of 1997; this was the bill that introduced the $1500 outpatient therapy cap that is still in law to this day (though the cap has increased a bit), however, as of right now it is not in effect. The therapy cap actually did go into effect for a short period of time from January to November 1999. Congress saw that the cap was not effective, so they instituted a two year moratorium on the therapy cap to prevent it from going into effect. After that moratoriums and exceptions were passed every time the previous ones expired, but the cap was never repealed. Some people might wonder, “What if the cap is never repealed, and a moratorium or exception runs out and congress does not pass another one?” This actually did occur in 2002. For months people fought against the cap going into effect, but in 2003 the cap finally went fully into effect. The cap was only in effect from September to December 2003, so it did not get a chance to do much damage before another moratorium was passed. Lawmakers have attempted to repeal the cap, but with no luck so far.
Most recently in 2015, an effort to repeal the cap was almost successful, but failed by two votes. Exceptions were extended until December 31st of this year, though. If the cap is not repealed by this date, or another moratorium not put into place, the cap will go into effect. There is a bill currently in congress to repeal the cap, as mentioned above, that is still gaining support.
Repealing the Medicare outpatient therapy cap is a vital piece of legislation that impacts the quality of healthcare. For 2017, Medicare has allotted only $1,980 worth of therapeutic services for speech-language pathology services and physical therapy services combined (ASHA, 2017). Not only does this fiscal limitation prove to be insufficient for our many severe patients suffering from speech, language, and swallowing/feeding deficits, it also does not take into account the severity of these diagnoses or the co-existing medical conditions of the patients, forcing them to continue to split their minute amount of fiscal resources allotted for their recovery between physical therapy and speech therapy. This cap may result in the premature termination of treatment for many patients when they are unable to pay out of pocket for the services that they need and deserve access to, hindering the recovery of a multitude of patients seeking the services of speech-language pathologists. It is the mission of healthcare providers to ensure quality and sufficient treatment to those in need, and it is the ethical responsibility of our government to ensure that these patients are provided with fair and adequate access to the medical services they are in need of.