PAN Works to End Medicare Therapy Caps

People with Parkinson’s often rely on physical, occupational, and speech-language therapy services to maintain quality of life and independence. PAN, in partnership with a coalition of provider and patient groups, has been working to ensure people with Parkinson’s and others with chronic conditions on Medicare maintain access to these medically necessary therapy services.

Brief history

In 1997, Congress created limits, or caps, on the amount of outpatient physical, occupational, and speech-language therapy a Medicare beneficiary can receive each calendar year (just $1,900 in 2013). However, many people with chronic conditions, like Parkinson’s, require therapy services beyond the cap. With this in mind, Congress created an automatic exceptions process that allows for people to receive therapy over the cap. Unfortunately, Congress has to vote to extend the exceptions process every year. If Congress does not pass an extension by December 31, people with Parkinson's and other chronic conditions will be forced to stop their medically necessary therapy or pay 100% of the cost out-of-pocket for services beyond the limit.

What’s happening now?

PAN is working diligently to ensure that people with Parkinson’s continue to have access to medically necessary therapy services by pursuing a permanent fix to the Medicare therapy caps in the long-term, as well as advocating for an extension of the exceptions process in the short-term.

Because of the uncertainty created by the Medicare therapy caps and the exceptions process, PAN supports the Medicare Access to Rehabilitation Services Act of 2013 (H.R. 713/S. 367), which would eliminate the therapy caps altogether. In addition to supporting this legislation, last week PAN signed a letter to both the Senate Committee on Finance and the House Committee on Ways and Means urging that the committees work to include a permanent fix for the therapy caps in their proposals to permanently fix the Medicare Sustainable Growth Rate (SGR). The SGR is a formula that is used to control spending by Medicare on physician services; however, the formula has proven to be flawed, and Congress must pass legislation to fix it every year to prevent a significant cut in physician payment rates. This year, there has been support from both the House and Senate to permanently fix the SGR, and PAN believes that any discussion of a permanent fix to the SGR should also include a permanent fix of the Medicare therapy caps. To read our letter to the committees, click here.

Given the possibility that Congress will not be able to come to an agreement on a permanent fix for the Medicare therapy caps before December 31, PAN is also requesting that Congress extend the exceptions process and encourages you reach out to your Members of Congress on this issue. Click here to send a message to your Members of Congress – it’s as simple as a few clicks!

Join PAN for a webinar to learn more!

If you’re interested in learning more about Medicare therapy services and PAN’s efforts, please join us for a webinar at 2 p.m. EST on November 21 for an in-depth look at the issue. RSVP today!


Date originally posted: November 8, 2013.