The Therapy Cap
and How it Affects You
Our goal at Elite PT is to have you back to doing what you enjoy most in life. While that’s our focus, we’re also aware of the financial aspects of receiving physical therapy. We realize that Medicare may not cover all of the services you need to get well again. The Balanced Budget Act of 1999 originally established the financial cap on therapy services. During the next several years, the situation went up and down. Moratoriums were placed on the cap, and then the cap would be reinstated. Then, in 2007, an “exceptions process” was established that allowed PTs to bill for services over the cap limits in certain, very specific, situations. The “therapy cap exceptions process” is only temporary and has to be reapproved by Congress every year or so. On December 31, 2017, the exceptions process expires again.
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$1,980 for occupational therapy (OT) services per year.
There is legislation in the U.S. House of Representatives and Senate to repeal the therapy cap once and for all. We, at Elite PT, are fighting hard to do our part to support the cap repeal efforts.
What do these numbers mean?
Once you’ve reached those total costs in therapy services, Medicare will no longer pay, unless we can definitively prove to Medicare that you will benefit from further PT and enact the exceptions process. Otherwise, you will be responsible for covering the rest of the cost. Even more importantly, if you’ve received physical, occupational, or speech therapy prior to visiting our office, the cost of these previous services will count toward your cap limit. We and many other opponents of the therapy cap believe the cap is a poorly considered, arbitrary limit that hurts the sickest of the sick in our communities. People who have multiple medical problems tend to reach the cap faster than others, and the care that they need and deserve is impacted by this arbitrary number. It can affect you , and in many cases, it already has!
What can you do?
As a patient, your voice is more important to our congressional delegation than anybody else! Reach out to your representatives and senators and tell them that you support the therapy cap repeal legislation. If you have any questions, ask us !
Congressman Ralph Abraham 202-225-8490
abraham.house.gov
Congressman Mike Johnson 202-225-2777
mikejohnson.house.gov
Senator John Kennedy 202-224-4623
As of 2017, these are the therapy cap limits designated by Medicare:
kennedy.senate.gov
Senator Bill Cassidy 202-224-5824
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$1,980 for physical therapy (PT) and speech-language pathology (SLP) services, combined, per year.
cassidy.senate.gov
Slow Cooker Sweet Potato Soup
Have A Laugh!
Ingredients •
3 pounds sweet potatoes, roughly chopped
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1 tablespoon garlic, minced
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1 onion, chopped
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5 cups chicken or vegetable stock
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2 stalks celery, sliced
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1 cup coconut milk
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2 medium carrots, chopped
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Sea salt and freshly ground black pepper
Directions 1. Place all the ingredients except for the coconut milk in a slow cooker. 2. Season everything to taste with sea salt and freshly ground black pepper. 3. Cover and cook on low for 6 hours or on high for 4 hours.
4. Puree everything until smooth, using a blender or an immersion blender. 5. Add the coconut milk, give everything a good stir, and cook for another 30 minutes. 6. Adjust the seasoning and serve warm.
Recipe courtesy of PaeloLeap.com.
Elite PT • (318) 443-3311 • 3
Recipe courtesy of CookingLight.com.
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