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Cap deadline passes, cap still in effect

Rehab Private Practice Alert, January 4, 2006

American Physical Therapy Association (APTA) President Ben F. Massey sent out a letter to all its members last week to help clear up some of the confusion about the therapy cap. Massey wanted to let all therapists know that Medicare therapy services are once again subject to two caps-one combined $1,740 cap for physical therapy and speech language pathology and a separate cap for occupational therapy.

He wrote, "In budget reconciliation legislation currently pending in Congress, there are provisions that would authorize the Centers for Medicare & Medicaid Services (CMS) to allow coverage for services beyond the cap if they are shown to be medically necessary. The reconciliation bill has been approved by the Senate but still must be voted on by the House, and this vote probably will not occur, at the earliest, before the end of January. In the meantime, the $1,740 caps go into effect on January 1 as described in current law.

"APTA is working with Congress and CMS to minimize the impact of these caps on beneficiaries until we can replace them with a system that assures beneficiaries receive the clinically appropriate care they need. We are urging CMS to develop and implement a simple and effective exceptions process that will allow patients to receive clinically appropriate care exceeding the cap. We will continue to work with Congress to repeal the therapy cap and create coverage and payment policies that will assure no Medicare beneficiary is denied the care they need.

"But today physical therapists need to take immediate action to make sure their practices are prepared on January 1 to protect patients and cope with the therapy cap."

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