ACR/ARHP Makes Another Push to Repeal Medicare Therapy Caps

H.R. 807, Medicare Access to Rehabilitation Services Act of 2017, will be one of the key issues discussed when members of the ACR’s Government Affairs Committee (GAC) visit Capitol Hill Sept. 26 during the annual Advocates for Arthritis event. This bill—as well as its companion bill in the Senate, S. 253—is aimed at repealing the cap on outpatient rehabilitation services.

Janet Stevens

“If we’re able to continue to raise awareness [of the issue] and keep it on people’s radar, the feeling is pretty optimistic that we will be able to accomplish its passage,” says GAC member Janet Stevens, clinical access manager, Department of Internal Medicine, University of Michigan, in Ann Arbor. She has been active in past efforts to repeal the therapy caps, which came close to passing in the 113th Congress (with 225 bipartisan cosponsors) and in the 114th Congress (238 cosponsors).

In these efforts, the ACR joins a long list of other patient advocacy and professional societies, such as the American Physical Therapy Association.

ARHP President Afton Hassett, PsyD, an associate research scientist at the University of Michigan, says, “We must join our partners and take action now to ensure that our patients will receive these critical, evidence-based elements of care. Nothing is guaranteed.”

Why a Repeal?
Arbitrary caps on Medicare outpatient physical therapy, speech language pathology and occupational therapy services were passed by Congress in 1997 as part of the Balanced Budget Act. Since that time, 16 temporary exemptions, which allow some extensions of care, have been passed by Congress. The latest exemption will expire in December.

As Karla Jones, RN, MS, CPNP, with the Division of Rheumatology at Nationwide Children’s Hospital in Columbus,

Karla Jones

Ohio, explains, after the first automatic extension of allowed services, the next level of approval requires a medical manual review. “When you go to the second round with the manual review, you can imagine that this takes significantly more time and energy. And the longer it takes, the more likely the patient will lose ground.”

That scenario, says Ms. Stevens, is not only “disappointing, but almost demeaning for our patients. The rheumatologic diseases are chronic and painful, and we know that exercise and movement are key pieces for helping [patients] manage their disease and quality of life. It would be far less expensive for us to manage on an ongoing basis with therapy than to risk a loss of functionality, leading to disability and other co-morbidities requiring expensive drugs and potential hospitalizations.”