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Rheumatology Leaders Praise Bipartisan Framework to Repeal Medicare Therapy Caps

Bipartisan agreement would repeal arbitrary caps on rehabilitation services, protect access to care for millions of Americans living with rheumatic diseases

ATLANTA – The American College of Rheumatology (ACR) applauds Congressional leaders for developing a bipartisan framework to permanently repeal the Medicare therapy caps beginning in 2018.

“This agreement brings us a big step closer to ensuring our Medicare patients continue to receive the vital rehabilitation services needed to maintain their mobility and quality of life,” said ACR President Sharad Lakhanpal, MBBS, MD. “The ACR has been a longstanding and vocal advocate for eliminating the Medicare therapy caps and we are pleased to see Congressional leaders come together around a bipartisan path forward to full and permanent repeal.”  

The framework, which was laid out in an agreement reached by the Republican and Democratic leaders of the House Ways & Means, Energy & Commerce, and Senate Finance Committees last week, would repeal the caps and require that claims submitted above the new threshold be marked with an appropriate modifier if determined to be medically necessary. The agreement would also continue the targeted manual medical review process that was established in 2015 by the Medicare Access and CHIP Reauthorization Act (MACRA), which members of both parties support.

The Medicare therapy caps were originally introduced in 1997 as a part of the Balanced Budget Act.   Arbitrary caps on outpatient therapy services covered by Medicare – including physical therapy, speech language pathology, and occupational therapy – were put in place in order to reduce federal spending and balance the federal budget. Though Congress has acted on 13 separate occasions to temporarily prevent their implementation, the current exemption is due to expire at the end of December. If allowed to go into effect in 2018, patients whose needs exceed the threshold would be responsible for 100 percent of the additional cost of their care – something many patients cannot simply afford.

The Medicare Access to Rehabilitation Act (H.R. 807), a bipartisan bill to permanently repeal the caps, has wide support in the House with 213 co-sponsors and is officially endorsed by the ACR. A companion bill in the Senate (S. 253) has 35 Republican and Democratic co-sponsors.

Jocelyn Givens
jgivens@rheumatology.org
404-633-3777, ext. 810

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The American College of Rheumatology (ACR) is the nation’s leading advocacy organization for the rheumatology care community, representing more than 9,500 rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care.

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