Medicare Therapy Cap Suspended -- Two-Year Moratorium Imposed
By Jenny Shao and Jennie Benson
On December 8, 2003 President Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act which included provisions immediately suspending enforcement of the 2003 Medicare therapy cap and imposing a moratorium through December 31, 2005.
The Medicare cap applied to Part B services in all outpatient therapy settings except hospital outpatient therapy and was designed as an annual financial limit on the amount of therapy services Medicare would cover per beneficiary. The therapy cap went into effect September 1, 2003 and imposed a combined limit of $1,590 for speech-language pathology and physical therapy services and a separate amount of $1,590 for occupational therapy. The cap was in effect 98 days before the moratorium went into effect December 8th.
This temporary victory can be attributed to the extensive advocacy actions by ASHA, its members, and other rehabilitation groups in educating federal lawmakers about the harmful impact of the caps.
The moratorium should not end our efforts to repeal the 1997 legislation that created the arbitrary therapy caps – particularly with threats of benefit limits resuming again in 2006. It is important that DSHA members and their patients unify in their efforts to prevent these caps from being implemented. Resources on the ASHA website (www.asha.org) are provided to keep speech-language pathologists and their patients informed of the current status of the therapy caps and to guide them in taking action to ensure that vital rehabilitation services remain available and affordable to Medicare patients.