Enactment of the Balanced Budget Act (BBA) in 1997 placed an annual cap on rehabilitation services under Medicare. Almost immediately Congress recognized the cap’s potential harmful effect on Medicare beneficiaries and moved to provide an annual exceptions process to prevent the actual implementation of a hard cap on physical therapist services as well as speech-language pathology and occupational therapy services. Because the process required congressional action to be renewed almost every year, a tedious routine emerged of having to repeatedly pass legislation to keep the exceptions process in place. APTA’s extensive lobbying campaign, which went on for a staggering 20 years, finally put a stop to the constant threat of implementation, when in 2018 Congress replaced the exceptions process with a permanent threshold process.