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.