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Dave Mason, APTA Vice President of Government Affairs.

The American population is living longer thanks to the advent of modern technology and greater health advances. Surviving conditions that years ago would have caused an earlier demise, the aging population requires medical visits and rehabilitation services for issues such as stroke, diabetes and Parkinson's disease.

Physical therapists (PTs), occupational therapists (OTs) and speech language pathologists (SLPs) have experienced an expanding elderly patient base, which has increased the need for research, not only in acute care but with functional outcomes (reintegration into daily living). Just as with any specialty, rehabilitation therapists sometimes run up against legislative issues that threaten to severely limit access and services.

Currently, rehabilitation services are on the verge of being hit with therapy caps. On Jan. 1, 2007, Medicare beneficiaries requiring physical, occupational and speech-language pathology rehabilitation will face a limit to how much therapy they can receive through Medicare. As it stands, the therapy cap placed on rehabilitation services is $1,740 for PT and SLP combined and $1,740 for OT. So far, patients have been protected by an exceptions provision adopted as part of the Deficit Reduction Act of 2005, which allows Medicare beneficiaries needing care above the capped amount to apply for exceptions. Without the provision, many seniors and people with disabilities who need physical therapy will face a choice between foregoing necessary care or paying entirely for care out-of-pocket when their coverage runs out.

Organizations like the American Physical Therapy Association (APTA) and the American Occupational Therapy Association (AOTA) have joined forces with numerous health associations to lobby Congress for revisions in the policies on therapy caps and the issue of direct access.

"Our immediate objective is to get the exceptions process extended for more than one year," explains Dave Mason, vice president of government affairs for APTA. "Patients and providers can have more comfort and time and (it provides more time) for CMS to perfect the process. CMS has ideas on how to refine the process function, but they are not making improvements in the program because of the deadline."

Reed Franklin, director of federal reimbursement policy for AOTA notes, "If Medicare is worried about spending, which they should be, rehabilitation is not the place to cut; it gets people out of the hospital faster." He adds, "There have to be checks and balances but to put an arbitrary cap on the therapy that everyone agrees is necessary is unwise."

Changing the therapy cap is the key reason these organizations continue to push for a longer extension to the exceptions process. They hope to either reach a compromise that will be more beneficial to patients or preferably, to repeal the cap altogether. Also, a longer extension will allow APTA and AOTA to focus their efforts on other endeavors, such as pilot projects and public health initiatives.

Christina Metzler, chief public affairs officer for AOTA, notes that OTs would like to focus more of their time legislatively on issues like home health and on working with the Veterans Administration to rehabilitate injured soldiers coming back from Iraq. Other burgeoning programs of interest include gaining federal support to provide healthcare training for people in lower socioeconomic brackets through subsidies to colleges and universities. Such support can bring more people into the medical profession and meet the expanding healthcare needs of the population.

So far, Mason says, there has been favorable support in the House and Senate to develop a Medicare bill this year carrying the therapy cap exception.

"We would love the opportunity to work on modifications to the Medicare payment system for outpatient therapy services without having to worry about the therapy cap," adds Mason, citing alternative methodologies such as pay-for-performance models. "In order to spend time on that, we hope to extend the therapy cap long enough so we can work on alternatives in 2007."

Direct access is another roadblock issue for Medicare patients. APTA and AOTA work equally hard on legislation to make state laws on access to therapists applicable to Medicare beneficiaries. Currently 43 states allow for direct access to physical therapists. Direct access eliminates the burden of a referral to receive physical and occupational therapy services. Referrals, they contend, cause a delay in care that can result in higher costs, decreased functional outcomes and patient frustration. While there has been solid congressional support, a gap remains in inking the provision into a bill.

"What happens when someone is used to going directly to a physical therapist, then they get older and because they have Medicare, then have to get a physician's referral?" poses Mason. "We don't think it should be any different."

"We support direct access for all therapies and equal treatment for all therapies," adds Metzler.

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