Eight Patient Groups Call Medicare Payment Reform Framework Incomplete

Call on Congress to Include Therapy Caps Repeal in SGR Legislation

DENVER—November 4, 2013—Eight patient and consumer organizations representing beneficiaries living with Parkinson’s disease, impairments associated with stroke, multiple sclerosis, spinal cord injuries, arthritis and other brain injuries, expressed concern over House Ways and Means and Senate Finance's failure to address the Medicare therapy caps in their recently released SGR reform framework and are calling on Congress to include a repeal of the therapy caps in any Medicare payment reform legislation considered by the Committees.

In a letter to the Chairman and Ranking Members of the Ways and Means and Finance Committees, the groups questioned the intent of the framework which would enact a new payment system for providers while leaving in place a policy that denies outpatient rehabilitation services to beneficiaries seeking services from some of those very providers.  The Balanced Budget Act of 1997 put in place both the financial limitations on outpatient therapy services and the SGR formula for Medicare outpatient reimbursement.  Both of these policies are flawed and for years Congress has enacted legislation to prevent both cuts to providers and the application of arbitrary limits on outpatient therapy services. 

 “We believe the Committee’s work to establish a reliable payment system for Medicare providers is critical and also represents an opportunity to seek resolution to a long-flawed policy impacting the ability of many to receive medically necessary rehabilitation care.  Addressing the Medicare therapy caps in SGR reform would help break the pattern of short-term patches and yearly extensions which collectively, put patient access to services at risk”, said Coral Cosway, Director of Policy Advocacy for the National Stroke Association.

Under current law Medicare is required to place a financial limitation on the amount of outpatient therapy that it will reimburse annually.  There is one combined cap of $1,900 for physical therapy and speech-language-pathology services and a second cap of $1,900 for occupational therapy services.  Early on, Congress recognized the detrimental effect of hard caps on therapy services and enacted a moratorium on the implementation of the policy, and in recent years passed legislation that includes an exceptions process and medical review.  If Congress fails to act on the policy this year, the hard caps will go back in place effective January 1, 2014.  According to the Medicare Payment Advisory Committee (MedPAC), almost 1,000,000 Medicare beneficiaries could see their access to therapy services discontinued if the hard caps on therapy services are allowed to go into effect.

Therapy services are essential in helping individuals regain and maintain function and allow those with serious conditions to lead productive lives and recover to their fullest potential.  For additional information contact Clair Diones, Director of Marketing and Communications at the National Stroke Association.


About National Stroke Association
National Stroke Association is the only national organization in the U.S. that focuses 100 percent of its efforts on stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke. Visit www.stroke.org for more information.

Press Contact: Clair Diones



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National Stroke Association’s mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke.