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Date
The Honorable _______________
U.S. Senate/U.S. House of Representatives
Washington, DC 20510/20515
Dear Senator/Representative ___________________:
As a concerned constituent and a physical therapy practitioner, I am writing to you about a
provision that originated in the Balanced Budget Act (BBA) of 1997 that harmed senior citizens
in 1999 anddoing so again effective January 1, 2006. This provision imposes an annual limit of
$1,740 per beneficiary for outpatient therapy services. This limitation, or cap, affects therapy
services provided in all Part B practice settings except for those furnished in a hospital
outpatient department.
Congress has recognized the potential consequences of the therapy cap and on three separate
occasions imposed a moratorium to prevent its implementation. Therefore, I urge you to take action
once and for all to remove the cap on therapy services and prevent further harm to Medicare
beneficiaries.
Congress is well aware of the inherent problems with the therapy cap:
- The arbitrary therapy cap (approximately $1,740 in 2006) will have a disproportionate impact
on those Medicare beneficiaries who need therapy care the most – the oldest and the sickest
– denying access to essential care for the most vulnerable Medicare population.
- Beneficiaries who require services above $1,740 will be forced to seek that care in an
outpatient hospital department –if one is available to them in their area – or face
paying 100 percent of the cost of additional treatment out of their own pockets.
- This arbitrary cap will limit access to necessary therapy if a patient has more than one episode
of care for therapy in a year – not uncommon for Medicare beneficiaries. For example, if one
of my Medicare patients has a knee replacement and receives $1,740 in therapy – and then
suffers a stroke or some other condition that requires therapy care later in the same calendar
year, Medicare will not cover those services if the $1,740 limit has already been reached.
(Add a paragraph talking about specific patients of yours that could be affected by the
cap.)
Senators John Ensign (R-NV) and Blanche Lincoln (D-AR) have joined with Representatives Phil
English (R-PA), Ben Cardin (D-MD), Roy Blunt (R-MO), and Frank Pallone (D-NJ) in introducing the
“Medicare Access to Rehabilitation Services Act” (S. 438/H.R. 916). This legislation
would repeal the arbitrary cap on therapy benefits once and for all. I strongly urge you to
cosponsor this important legislation and actively work for its adoption as soon as possible.
Medicare beneficiaries will suffer irreparable medical and economic harm unless the cap is repealed.
Thank you for your consideration. I look forward to hearing of your support of the Medicare Access
to Rehabilitation Services Act and your action to repeal the therapy cap once and for all.
Sincerely,
Your Contact information
Be sure to sign the letter and include your address so the member of Congress knows
you are a constituent residing in his or her district.
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