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therapy cap
In 1997 the Balanced Budget Act established annual per-beneficiary Medicare spending limits, or therapy cap, for outpatient therapy services covered under Medicare Part B. 〔() Medicare Provisions in Balanced Budget Act of 1997.,〕 These services include Physical Therapy, occupational therapy and speech language pathology. Facilities affected by the therapy cap include: private practice, physician offices, skilled nursing facilities, rehabilitiations agencies, comprehensive outpatient rehabilitation facilities, critical access hospitals, and outpatient hospital departments. For 2014, the therapy cap amount is $1920 for physical therapy and speech pathology combined. A separate $1920 is allowed for occupational therapy services. Beneficiaries enrolled in Medicare Advantage plans are not subject to the therapy cap unless the plan chooses to apply the cap.〔() Medicare Therapy Cap 2014.,〕
Beginning in 1999 Congress has placed repeated moratoria on the Therapy Cap through 2006. In 2006, an exception process was put into place through the Deficit Reduction Act of 2005. The exception process allowed for additional therapy services to be provided “when medically necessary” up to $3,700 after which, a manual medical review is required before further payment will be provided. Once the cap is reached, patients are allowed to pay out of pocket for further services.〔(Monetary cap translates to 2 months )〕 Without further legislation the therapy cap exception process will expire on March 31, 2015. At this time hospital based outpatient clinics will no longer be subject to the therapy cap. 〔(History of Medicare Therapy Caps )〕
==Controversy==
Several medical associations and organizations including the American Physical Therapy Association and American Occupational Therapy Association have lobbied against therapy caps because the bill restricted disabled seniors, stroke patients, and other severe cases from receiving therapy treatments.〔(APTA advocacy )〕
Another controversy is the original bill combined physical therapy and speech therapy together allowing only a shared $1810 per calendar year for both therapy services. This error has yet to be corrected by congress, further limiting therapy services to outpatients.
抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』
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