Two decades of advocacy come to successful fruition, as a 2-year funding deal recently signed into law includes a full repeal of the cap on Medicare outpatient occupational therapy, physical therapy, and speech-language pathology services.
“For 20 years the therapy cap threatened to undermine the health and quality of life of millions of Medicare beneficiaries. Occupational therapy practitioners were faced with the possibility of denying services to those who needed them. This victory is a collective one that brought AOTA members, consumer groups, other providers, and Congress together to find a solution,” says Amy J. Lamb, OTD, OT/L, FAOTA, president of the American Occupational Therapy Association, in a media release.
“I am grateful that Congress has finally put an end to this flawed policy and would like to thank all of our Congressional champions for their tireless work.”
The repeal came just as some beneficiaries were beginning to hit the $2,010 therapy cap. With the turn of the calendar year, the therapy cap of $2,010 went into effect, and putting more than a million beneficiaries at risk of losing access to essential outpatient Medicare Part B therapy services, the release explains.
Since the passage of the Balanced Budget Act in 1997, consumers have been threatened with a limitation on the amount of occupational therapy, physical therapy, and speech-language pathology they could receive under Medicare Part B. During this time, AOTA has worked alongside the American Physical Therapy Association (APTA), the American Speech-Language-Hearing Association (ASHA), and a broad coalition of consumer and provider organizations to repeal the arbitrary and harmful barrier to care for a wide spectrum of Americans in need of rehabilitation and habilitation services.
AOTA has fought this policy since 1997. A bipartisan proposal was agreed to last fall, following release of AOTA’s study on the positive impact of medical review over the past several years. The data showed patients were still receiving therapy even at the highest levels, yet costs were going down. Because of this information, the cost for a full repeal went down substantially, making the path to repeal more open, the release continues.
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