A Bitter Choice
As an occupational therapist, I’ve seen how my profession can help empower clients across their lifespans. We’ve helped people get their lives back after illness and injury. Occupational therapy specifically helps my clients return to the activities that increase function and make them feel whole again, from bathing and dressing, to driving a car and getting back to work.
Congress’s inability to fix a 20-year-old, flawed policy means that some of our nation’s most vulnerable are facing a tough choice: Pay out of pocket to continue necessary therapy, or halt therapy services — and stop the recovery process.
On January 1, 2018, a limitation on Medicare Outpatient Therapy Services, also known as the “therapy cap” went into place after Congress failed to extend the “exceptions process” that previously kept the cap from taking effect for patients with a demonstrated need for additional services.
Currently, for 2018, the therapy cap places a financial limit of $2,010 on occupational therapy services and a financial limit of $2,010 on physical therapy and speech-language-pathology services combined. The therapy cap applies to most Medicare Part B providers of therapy services.
Stopping or even postponing therapy services can be detrimental to my clients’ quality of life, including the ability to care for themselves.
Congress has indicated that it is committed to fixing the problem of the therapy cap, but has not yet taken action to do so. While a policy can be applied retroactively, therapy cannot. For many conditions, if you miss the window of recovery by delaying treatment or decreasing intensity, that window may be closed forever. For degenerative conditions, lack of access to therapy can mean losing skills that will never be regained.
Fixing the therapy cap needs to happen and it needs to happen now. It can be done. And it should be done. Congress needs to ensure that seniors have access to the Medicare benefits they have been promised. They should move this bi-partisan, bi-cameral legislation, without delay.