It's not just the Children's Health Insurance Program and community health centers that Republicans decided to neglect last year in pursuit of their big tax cuts and to have some hostages for the upcoming budget fight. It turns out that millions of Medicare beneficiaries could be footing huge bills because Congress didn't get around to dealing with it.
For two decades, Medicare has capped how much it will pay for physical, speech and occupational therapy. But ever since the limits were imposed, Congress has passed an automatic exception that allows Medicare to pay for care beyond the caps when the treatments are deemed medically necessary.
The latest exception expired Dec. 31, which means the caps of $2,010 for physical and speech language therapy and $2,010 for occupational therapy are now being enforced. These services fall under Medicare Part B, which covers doctor visits and other outpatient services. When the exceptions were in place, Medicare beneficiaries paid only the 20 percent coinsurance that Part B requires.
So people recovering from strokes, or hip fractures from a fall, or who need ongoing therapy for chronic conditions are soon going to be forced to figure out how to pay, or go without the care they need. As of January 25, Medicare started processing claims as patients hit the cap.
In a conference call coordinated by AARP Thursday, representatives for the American Occupational Therapy Association, the American Physical Therapy Association and others said clients are already being forced to pare back or cancel services because of out-of-pocket costs.
Overall, about one-sixth of the 6 million Medicare patients receiving therapy each year surpass the cap, experts said.
“There is a sense of urgency that Congress must act,” said Justin Elliott, vice president of government affairs for the American Physical Therapy Association. “If this drags on until March, we're going to have more compounding problems.”
This has been a routine thing Congress deals with. Yes, it would make more sense for them to change the law and remove the caps, but they're not very good at fixing stuff. They're pretty good at maintenance though, or used to be. But with Republicans in control now, all bets are off, as we’ve seen with both CHIP and community health centers. Nothing that used to be routine is any more. Except the use of these programs as hostages. They’re doing it again with this and community health centers, suggesting that they’ll include them in the next short-term spending bill. That’s “to attract votes” says Rep. Tom Cole (R-OK).
