The American Occupational Therapy Association (AOTA) is pleased to announce that a major step forward has been made in achieving full repeal of the Medicare Outpatient Therapy Cap. The three Congressional Committees that oversee the Medicare Outpatient Therapy Cap announced that they had reached a bi-partisan bicameral agreement on a policy framework that would permanently repeal the therapy cap. 

The draft policy, which must go through the legislative process, would repeal the therapy caps but continue with some activities to assure appropriate utilization: requiring an appropriate modifier (the KX modifier) certifying medical necessity and reasonableness, and continuing the current system of targeted review of claims over a $3,000 threshold.

AOTA has been working hard with staff in both the House and Senate, and the Committees have made repealing the therapy cap a priority. A study done through AOTA early in 2017 has been used by staff to make judgments about how to craft the policy. The proposal has not yet been introduced as legislation.

“We appreciate the hard work of the committees to draft this policy. We must continue to work to assure that this hard work of so many comes to fruition in law over the next months,” said Christina Metzler, AOTA Chief Public Affairs Officer. “Crafting this approach is step one. Beyond this agreement, there are many more hurdles ahead such as what legislative vehicle will be used to move this forward and how Congress will pay for it.”

For the past 20 years after the passage of the Balanced Budget Act in 1997, consumers have been limited in the amount of occupational, physical, and speech-language pathology therapy they could receive under Medicare Part B. For several years, AOTA has worked alongside the American Physical Therapy Association (APTA) and the American Speech-Language-Hearing Association (ASHA) to repeal the arbitrary and harmful barrier to care for a wide spectrum of Americans in need of rehabilitation and habilitation services.

Nationwide, more than 213,000 occupational therapy practitioners help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations). Legislation supporting access to occupational therapy and other rehabilitation services can reduce overall health care costs by facilitating independence among patients. A 2016 independent study found that occupational therapy reduces hospital readmission and costs to patients. To learn more about this 100-year-old profession, visit www.aota.org.