With the previous patch on the Outpatient Medicare Therapy Cap expiring on December 31, 2017, the American Occupational Therapy Association (AOTA) is working harder than ever to have legislation passed that would completely repeal the therapy cap. With the turn of the calendar year, the therapy cap of $2,010 went into effect, and now more than a million beneficiaries are at risk of losing access to outpatient Medicare Part B therapy services.

“The beneficiaries who need these services represent the most vulnerable people receiving Medicare, including those who have had a stroke or have conditions such as Parkinson’s disease, multiple sclerosis, or ALS,” said Amy J. Lamb, OTD, OT/L, FAOTA, President of AOTA. “For 20 years we have been asking AOTA members and beneficiaries to advocate for access to therapy services that are proven to produce positive outcomes and enhance quality of life. With bipartisan agreement on a permanent fix, we must let Congress know that two decades is enough and this arbitrary policy must be repealed.”

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

“With many issues still up in the air from 2017, Congress has given no indication of when it will address the cap on Medicare Part B therapy services,” said Christina Metzler, Chief of Public Affairs for AOTA. “There is a commitment by many of our Congressional champions to end the cap once and for all, but many steps must be taken to make this a reality, and the Congressional calendar is crowded.”

Some beneficiaries will soon begin to hit the $2,010 therapy cap.

While we wait for Congress to act, AOTA is advising therapy professionals to issue a mandatory Medicare notice, called an Advanced Beneficiary Notice of Non-Coverage or “ABN” (https://www.cms.gov/medicare/medicare-general-information/bni/abn.html) to all Medicare beneficiaries they treat who may go beyond the $2,010 cap. The ABN is issued in situations where Medicare payment is expected to be denied. Because Congress didn’t extend the exceptions process permitting the attachment of a KX modifier or the manual medical review process, patients must be notified that their therapy services may be limited.

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.

For updates about the Therapy Cap, visit www.aota.org .