Advocating for Repeal of $1500 Cap

[Guest guest]

As originally passed, the Balanced Budget Act of 1997 caps Medicare

reimbursement for outpatient occupational therapy, physical therapy, and

speech-language services at $1500. The original intent was that this cap

was per patient, per year, per discipline. As it is being interpreted by

the Health Care Financing Administration (HCFA), there is one $1500 cap for

OT, and another $1500 cap to be shared by PT and Speech.

ASHA, AOTA and APTA have been working to repeal the $1500 limit.

Congressman Ensign (R-NV) has introduced H.R.3835 to repeal the cap,

but the bill needs YOU to help find cosponsors!

ACTION NEEDED

Please call, email, or write your U.S. Representative and --

Ask him/her to sign on as a cosponsor to H.R.3835

Explain that the cap must be repealed because it will deny Medicare

beneficiaries access to essential care (use case histories if available).

Advise him/her that the $1500 cap is arbitrary, and there have been no

Congressional hearings on reimbursement for outpatient rehabilitation

services, especially the $1500 cap.

Let him/her know that there is no basis for putting physical therapy and

speech-language services under the same cap.

Ask for a response to your communication.

MODEL LETTER

Date

The Honorable (full name)

U.S. House of Representatives

Washington, DC 20515

Dear Representative (last name):

As your constituent and a (PT / OT / speech-language pathologist), I am

writing to request that you cosponsor and support legislation introduced by

Rep. Ensign of Nevada. The bill, H.R.3835, the " Reinstatement of the

Rehabilitation Benefit for Seniors Act of 1998, " will repeal the arbitrary

cap on outpatient rehabilitation services and replace it with a payment

methodology for those services based on classification of individuals by

diagnostic category, functional improvement, and prior use of services.

Please be assured that $1500 for outpatient rehabilitation services is

inadequate for someone who has a stroke and needs both speech-language

pathology services and physical therapy. I believe that $1500 is

insufficient for any of the individual services alone.

I do not believe you intended to severely limit or eliminate a Medicare

benefit that is the right of older Americans according to the Medicare law.

I realize that a payment system should be used that will inhibit or

eliminate fraud and abuse. Rep. Ensign's legislation does that by requiring

a new payment methodology that will have an impact on the provider and not

the beneficiary.

I understand that hospitals are excluded from the $1500 cap so that

patients who need additional rehabilitation can have access to the services

from a different provider. I do not see this as a realistic measure. Too

many older Americans do not have hospital rehabilitation services nearby

because of rural locations or because their hospital does not offer any or

all rehabilitation services.

I agree that there is a need to control the escalating costs of Medicare,

but an arbitrary cap is not the answer. .

Please let me know your views on this very important issue and whether you

will become a cosponsor of H.R.3835. Thank you.

Sincerely,

Your Name/Address

HOW TO ADVOCATE

All U.S. Representatives can be reached through the Capitol switchboard at

. If you are uncertain about the name of your representative,

the operator can identify him/her by zip code.

Not all members of Congress have email addresses at this time. Be sure to

include your name and address in the body of your email so you can be

correctly identified as a constituent.

R. Kovacek, MSA, PT

KovacekManagementServices, Inc.

The FOCUS Group, Inc.

20225 Danbury Lane

Harper Woods, MI 48225

Fax

Email Pkovacek@...

<http://www.theFOCUSgroup.net>

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