WASHINGTON -- Congress has enacted legislation imposing a two-year moratorium on limits placed on Medicare outpatient rehabilitation services that exceeded $1,500. In March, Rep. Benjamin L. Cardin introduced legislation that would allow Medicare beneficiaries to receive necessary outpatient rehabilitation services in excess of arbitrary $1,500 caps set by Congress.

In 1997, Congress imposed a $1,500 cap on physical therapy and speech-language pathology services, and a separate $1,500 cap on occupational therapy services as a cost saving measure. In previous measures, Congress delayed implementation of the caps until Jan. 1, 2003. After several administrative delays, the Centers for Medicare and Medicaid Services (CMS) implemented the caps on September 1, 2003. This new legislation will further delay the caps until Jan. 1, 2006.

"This is a victory for Medicare beneficiaries who require extensive rehabilitation for strokes, hip fractures, and other serious conditions," said Rep. Cardin, a member of the Ways and Means Committee. "Outpatient rehabilitation therapy is the only service provided in Medicare Part A or Part B that is subject to dollar limitations. While I am pleased about the two-year moratorium, our next step is to repeal the caps on rehabilitation services entirely."

Rep. Cardin was joined by Republicans Phil English (PA) and Roy Blunt (MO), and Democrat Frank Pallone (NJ) as original sponsors of the Medicare Access to Rehabilitation Services Act of 2003 (HR1125). The legislation, which has 242 co-sponsors, also requires Medicare to reimburse for necessary therapy services based on the patient’s condition rather than on financial considerations.

"Studies show that more than one in 10 Medicare beneficiaries who receive outpatient rehabilitative services exceed the $1,500 caps. Many seniors with more serious conditions often surpass this dollar limit, forcing them to pay out-of-pocket for their care," said the Congressman. "Medicare should cover necessary therapy services. Providers shouldn’t be forced to keep one eye on the patient and the other on a calculator."