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Judge Upholds Outpatient Therapy Cap for Medicare Recipients

  • October 4th, 2003

A federal judge's ruling means that Medicare recipients who have suffered strokes or who have chronic illnesses like Parkinson's disease may lose the chance to regain mobility and other functions.

U.S. District Court for the District of Columbia judge Emmet G. Sullivan ruled September 29 that the Bush administration can enforce a $1,590 annual cap on outpatient physical therapy for Medicare beneficiaries, despite the administration's failure to provide notice to the 41 million Americans with Medicare.

The cap, which officially took effect September 1, limits how much Medicare will pay for outpatient physical, speech and occupational therapy. The therapy caps are $1,590 each year for physical and speech therapy combined, and an additional $1,590 each year for occupational therapy. The Medicare Rights Center, a national consumer group, estimates that therapy patients are likely to meet the cap in eight to ten visits, yet studies show that many types of patients benefit from far more extensive rehabilitation.

"The ball is now in Congress's court,' said Medicare Rights Center president Robert M. Hayes, who called the cap "an arbitrary and inhumane way to ration health care." Forty-nine senators and a majority of members of the House of Representatives are sponsoring legislation to repeal the therapy cap. Meanwhile, House and Senate conferees negotiating the Medicare overhaul bill already have agreed to hold off the therapy cap until 2005, but it is uncertain whether the conferees will agree on final Medicare legislation by year's end.

For the Medicare Rights Center's press release following the ruling, go to: www.medicarerights.org/pressrelease200325frameset.html

Local Elder Law Attorneys in Ashburn, VA

Judith Mitnick

Needham Mitnick & Pollack, PLC
Falls Church, VA

John Laster

Law Offices of John L. Laster
Falls Church, VA

Samantha Fredieu

Hale Ball Carlson Baumgartner Murphy PLC
Fairfax, VA


Last Modified: 10/04/2003

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