"The caps are arbitrary," Grassley said. "They are based on the bottom line, not on what the patient needs. We have to make the patient the priority. The change I secured would allow seniors to receive rehabilitative therapy based on their medical conditions, not on arbitrary payment limits."
Grassley said he obtained the change through the House-Senate conference committee on Balanced Budget Act adjustment legislation. Grassley's proposal, included in the Senate version of the bill, Tuesday night prevailed in conference committee. He successfully fought for his proposal to remain intact.
Grassley's language places a two-year moratorium on the existing caps on rehabilitative therapy. The moratorium goes into effect Jan. 1, 2000. It also requires the Secretary of Health and Human Services to report to Congress by Jan. 1, 2001, with recommendations on how to assure appropriate utilization of these services and how to appropriately reimburse for such services.
Grassley turned back an attempt by a House conferee to delay the moratorium by at least nine months. The conferee wanted to delay the moratorium until the Health Care Financing Administration (HCFA) implements a new billing system for Medicare Part B services in nursing homes. Grassley argued that the issues were unrelated, and patients should not suffer over a billing system. His argument prevailed.
Grassley initially received approval of his proposal in the Finance Committee chairman's mark of Balanced Budget Act adjustment legislation. Grassley is a senior Finance Committee member and sponsor of legislation to ease the therapy cap. He is also chairman of the Senate Special Committee on Aging.
The therapy caps originate with the Balanced Budget Act of 1997, which included a $1,500 cap on occupational therapy and a combined $1,500 cap on physical and speech therapy received in all settings except hospital outpatient departments, Grassley said. Congress imposed the caps after a dramatic increase in provider billings indicated some provider abuse of the benefit.
Many older Americans will never need services exceeding the $1,500 caps, Grassley said.
Others, such as stroke victims and those with illnesses such as Parkinson's disease, quickly will exceed the caps with just a few sessions of therapy. Those who need rehabilitative care the most will be penalized by being forced to pay the entire cost for these services.
"The therapy caps impose a hardship on the sickest Medicare patients," Grassley said. "We need to fix this problem for good. I'm pleased that the House and Senate conferees have agreed to my proposal to revisit this issue and adopt a fair policy for those in need."