The Medicare Payment Advisory Commission (MedPAC) has recommended to Congress that the caps on outpatient therapy services should be slashed by more than one-third and a review process for any patient who asks to go above the caps should be mandated. In justifying its recommendation, MedPAC stated that “Medicare’s outpatient therapy benefit is vulnerable to abuse and lacks clear guidelines to determine the appropriate frequency, type and duration of the outpatient therapy services.”
Despite serious concerns with many of the recommendations, the Therapy Cap Coalition (a group of approximately 50 national organizations, including LeadingAge) “is pleased by the Commissioners’ recognition that a hard cap on outpatient therapy without an exceptions process would create enormous barriers to care for tens of thousands of seniors across the country. However, MedPAC’s recommendation to lower the annual allowable limits for outpatient therapy services from $1,880 to $1270 is particularly troubling to the rehabilitation community. Under such a proposal, Americans most in need of rehabilitation therapy would, undoubtedly, see their recovery efforts halted by delays in care and barriers to access.”
The coalition is urging Congress to reject this approach and recognize the value of therapy which results in lower health care costs and improvement in quality of life for patients and consumers requiring these services.
The full report was released on June 17, 2013, entitled Report to Congress: Medicare and the Healthcare Delivery System. It can be downloaded here.
Contact: Lori Costa, Policy Consultant and Eric Dowdy, Vice President of Policy, (916) 392-5111.
