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Letters: Therapy cap in Medicare harms patients

The New Orleans Advocate - 2/14/2018

Congress' inability to fix a 20-year-old flawed policy means that some of our nation's most vulnerable citizens 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, 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.

I've seen how stopping or even postponing therapy services can be detrimental to a patient's quality of life, including the ability to care for themselves.

Congress has indicated that it is committed to fixing the problem of the therapy cap but has not yet taken action to do so. 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. For degenerative conditions, lack of access to therapy can mean losing skills that will never be regained.

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. They should move this bipartisan, bicameral legislation, without delay.

Kenneth Fogg

general counsel, Plantation Management Company

Baton Rouge


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