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Federal Judge upholds limits on Medicare-Covered therapy

 [Washington, D.C.]September 28, 2003 – Federal district court judge Emmet G. Sullivan today cleared the way for the Bush Administration to enforce a $1,590 annual Medicare therapy coverage cap despite its failure to provide notice to the 41 million Americans with Medicare.

“The ball is now in Congress’s court,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer group. “At this moment, 49 senators and a majority of representatives are sponsoring legislation to repeal the therapy cap. House and Senate conferees negotiating the Medicare overhaul bill already have agreed to hold off the therapy cap until 2005.

 "And consumer groups and the Bush Administration agree that the cap is an arbitrary and inhumane way to ration health care,” Mr. Hayes said.

“But because the machinery of Congress is broken, many Americans—people who have suffered strokes or who have chronic diseases like multiple sclerosis or Parkinson’s disease—will now lose their ability to regain mobility and other functions,” Mr. Hayes said.               

A suit brought by the Medicare Rights Center, Easter Seals and the American Parkinson Disease Association claimed that the Bush Administration failed to provide notice of the new limitation in coverage to many of the 41 million Americans with Medicare. 

Faced with the suit, the Bush Administration initially agreed to put off implementation of the therapy cap from January to July 2003. Suit was filed in June and, once again, the Bush Administration agreed to delay implementation of the coverage cap from July 1st until September 1st, and pledged to advise in writing at least 90 percent of people with Medicare that the cap was going into effect. 

        The therapy limits apply to outpatient therapy received at:

·        therapists’ or physicians’ offices;
·        outpatient rehabilitation facilities;
·        skilled nursing facilities for outpatients or residents who do not have Medicare-covered stays; and
·        home, through therapists connected with home health agencies, when not part of a Medicare-covered home health benefit.