Why Is Outpatient Rehabilitation Therapy Important? 

Many individuals with disabilities and chronic conditions depend on outpatient rehabilitation therapy to regain and/or maintain their maximum level of function and independence.  Such services include physical therapy, occupational therapy and speech-language pathology.

What is the Outpatient Therapy Cap?

As part of the Balanced Budget Act of 1997, payments caps were placed on reimbursements for Medicare Part B outpatient physical therapy, occupational therapy, and speech language pathology services.  Since 1997, Congress has stopped these caps from going into effect by placing a series of moratoria on them.  Because of this, the caps were only in effect in 1999 and for a few months in 2003. 

Rather than extending the moratorium indefinitely, in 2006 Congress created a diagnostic and clinically-based exceptions process to the financial caps on outpatient rehabilitation services. This process has enables people who need more outpatient rehabilitation services to receive treatment but the exceptions process is set to expire on December 31, 2007 unless Congress act again. 

The outpatient rehabilitation therapy caps, if implemented without an exceptions process, would most significantly hurt the exact individuals who could benefit from outpatient rehab therapy the most – those with severe and long-term disabilities or chronic conditions.

Legislation has been introduced in both the Senate and the House (S. 450/HR 748) that would repeal the caps on outpatient therapy.  CPR strongly supports enactment of this legislation.

The House recently passed the Children’s Health and Medicare Protection (“CHAMP”) Act of 2007, which includes a two-year extension of the exceptions process for Medicare’s caps on outpatient therapy services. CPR hears from its clinician and consumer member organizations that the exceptions process for the outpatient therapy caps currently in place generally ensures that individuals in need of extensive physical therapy, occupational therapy and/or speech-language pathology services receive them. CPR applauds the House passage of this legislation and encourages Senate action.

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