Many of us are familiar with therapy services either for ourselves or our loved ones. These can include physical therapy, occupational therapy, and/or speech language therapy. Some members of our community receive therapy services in their homes, while others travel to clinics or medical offices.
For those of us on Medicare, we are also familiar with an annual Therapy Cap that was enacted by Congress in 1997 which requires patients to pay out-of-pocket once they have reached the limit Medicare will reimburse for services. The cap is low, putting many members in our community in a position where they either have to stop receiving services because they cannot afford to pay out-of-pocket, or take on medical debt. Even those who have private insurance are not immune to a therapy cap. Many private insurance companies often follow the Medicare guidelines, putting those with private insurance in the same challenging position. Because these caps can be so harmful to some beneficiaries, Congress has frequently enacted an exceptions process to allow these patients a way to avoid paying for their long-term care out of pocket, but only for short periods of time.
Can we eliminate the Therapy Cap?
As of January 1st, patients are once again restricted to a hard cap of $2,010 in therapy services. After they hit $2,010, Medicare will no longer cover the costs. Depending on the circumstances, some patients may hit the cap as soon as January or February. So there is urgency for us, as Hydrocephalus advocates, to take up the cause.
Throughout the last few months of 2017, the Hydrocephalus Association has worked with patient groups and others to persuade Congress to simply eliminate the Cap. This was met with some success. A group of Senate and House committees reached a lesser agreement which improved on the previous exceptions process, but Congress never moved on this bipartisan compromise before the end of the year, as had been hoped. The decision was left in limbo with the debate around continued funding of the government (the CR).
Every passing day, more and more patients get closer to reaching the cap. Patient groups asked the Centers for Medicare and Medicaid Services to halt enforcement of the cap until Congress passes a fix. CMS agreed to hold all claims related to the therapy cap for a period of time, but a permanent solution is needed now.
On Jan. 22nd, Senator Ben Cardin of Maryland urged the Senate to help find a permanent solution when preparing spending legislation over the next month. He is a champion of stopping the Therapy Cap. You can follow the active advocating on Twitter using #StopTheCap.
Patrick Cooney, President of The Federal Group (@Cooney7468) had a positive meeting with House Majority Leader Kevin McCarthy’s office (@GOPLeader) and has been told the previously negotiated Therapy Cap repeal policy will be included in the CR to extend government funding past February 8th.
Other organizations have been pushing Therapy Caps strongly, including the American Occupational Therapy Association, Inc. (AOTA), the American Physical Therapy Association (APTA), and the American Association of Retired Persons (AARP), who is doing an online email push and will hold a press conference this Thursday, February 8, at 2pm.
What can you do?
Join the push via social media to our elected officials and/or contact your Senators and Representative directly about this issue. Patients should not be hurt simply because Congress has not done its job. Ask your congressional representative to permanently repeal the therapy cap.
Find your Senator here or call (202) 224-3121.
On social media, use #StopTheCap and don’t forget to tag us (@HydroAssoc) so we can like and retweet!