Medicare Therapy Caps

What are the Medicare Therapy Caps?  

The Balanced Budget Act of 1997 created limits, or caps, on the amount of outpatient physical, occupational, and speech-language therapy a Medicare beneficiary can receive each calendar year.  Beginning in 1997, Congress voted several times to keep the caps from going into effect.  However, on January 1, 2006, Congress allowed the therapy caps to take effect.  The cap for 2013 is $1,900, and once it is reached, beneficiaries who require additional services in the calendar year are responsible for 100% of the cost.

Exceptions to the Medicare Therapy Caps

To mitigate the impact of the therapy caps on Medicare beneficiaries who need therapy services beyond the cap, in 2006, Congress created an exceptions process for services deemed medically necessary.  Unfortunately, the exceptions process is temporary and must be reauthorized by Congress every year.  In January 2013, Congress passed, and the president signed, a continuation of the exceptions process.  This extension expires December 31, 2013.

PAN supports a repeal of the Medicare therapy caps.  People with Parkinson’s disease commonly have a medical need for physical and speech language therapy.  The Medicare therapy caps place an unnecessary burden on many individuals with Parkinson’s and other diseases, whose annual costs for these services exceed the cap.  In addition, if an exception is not granted by Medicare, the beneficiary may face the decision of forgoing care, paying out of pocket for the services, or traveling to an outpatient hospital for continued care.