As an occupational therapist, I’ve seen how my profession has helped people get their lives back after illness and injury. However, Congress’ 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 Jan. 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.
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.
If the therapy cap remains in effect, patients will lose access to therapy services critical to their ability to be as independent and functional as possible. 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.