LeadingAge: Medicare Therapy Caps Exceptions Process Expires December 31. With the Medicare therapy caps exceptions process set to expire as of Jan. 1, 2012, all Medicare beneficiaries once again are at risk for the cost of physical, speech and occupational therapy costs in excess of the annual caps.
We urge everyone to Contact Congress and tell your legislators to extend the Medicare therapy caps exceptions process before Congress adjourns for the year.
About the Medicare Therapy Caps
The caps, $1,880 annually for speech and physical therapy and $1,880 for occupational therapy, are arbitrary and do not take into consideration the amount of therapy older people often need following a stroke, hip fracture or other serious illness or injury.
The caps also would impose a hardship on beneficiaries who experience more than one injury or spell of illness in a year.
The exceptions process allows Medicare beneficiaries with specific health conditions to have coverage for the amount of medically necessary therapy they require without regard to the caps.
The process has worked well since its implementation a few years ago, protecting against over-utilization of the therapy benefit while giving beneficiaries access to therapy services they need.
If the process is not extended, beneficiaries have the choice of seeking therapy from a hospital outpatient department, paying out-of-pocket for therapy that exceeds the caps or delaying therapy and potentially suffering a deterioration in their condition.
Long Term Care Rehabilitation 