Happening Right Now: Medicare Therapy Caps
Studies show that the quality of life for people with paralysis improves greatly with extensive physical therapy. However, in 1997 the Balanced Budget Act included a provision that placed payment caps on outpatient rehabilitation services covered by Medicare. After the annual cap has been reached, beneficiaries face the decision of forgoing care, paying out-of-pocket, or traveling to an outpatient hospital for continued care.
Congress has recognized the negative impact of the therapy caps and has voted several times to keep the caps from going into effect. Thanks to the hard work of advocates across the country, Congress has again passed legislation that ensures that Medicare beneficiaries living with spinal cord injury and paralysis are not forced to choose between foregoing necessary medical care or paying 100 percent of the cost out-of-pocket. Without Congressional action, the harmful caps would have taken effect on March 1, 2012, but Congress acted and recently extended the therapy caps exception process through December 31, 2012.
Although this is a step in the right direction, the Reeve Foundation will continue the important work of educating Members of Congress on the devastating impact that therapy caps would have on people living with spinal cord injury and paralysis, and will continue to urge Congress to come up with a permanent solution to the problem.