Hard Cap on Physical Therapist Services Under Medicare Is Eliminated.

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. 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 to put a stop to the cap with a permanent fix went on for a staggering 20 years.

In October 2017, things reached a tipping point. APTA representatives attended a meeting on Capitol Hill during which lawmakers from the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee announced that they’d reached a bipartisan, bicameral agreement to end the therapy cap. It looked like the cap might finally be on the way out for good. Unfortunately, Congress failed to pass a Medicare extenders package, which included a permanent fix to the therapy cap, by the end of the year. As a result, their latest extension of the exceptions process expired, and the cap was set to become a reality on January 1, 2018.

APTA redoubled its efforts in January, calling for members to join forces and contact Congress to demand a permanent fix to the therapy cap. Congress heard, and in February 2018, as part of a sprawling bipartisan budget deal, a permanent solution to the problematic hard cap was enacted, ending the 20-year cycle of patient uncertainty and wasteful short-term fixes.

In response to the long-sought legislation, APTA President Sharon L. Dunn had this to say: “Stopping the hard cap is a victory for our patients, and for our dedicated advocates. For 2 decades we have held back the hard cap through repeated short-term fixes—17 in total—that were achieved each time only through significant lobbying efforts by APTA and other members of the Therapy Cap Coalition. In that time, the hard cap was a genuine and persistent threat to our most vulnerable patients, a threat we saw realized earlier this year when Congress failed to extend the therapy cap exceptions process. Today that threat has been eliminated.”

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