ARTICLE: Medicare Cap On Therapies OK'd

[Murray Charters <mcharters@xxxxxxxxxxxxxx>]

Medicare Cap On Therapies OK'd

By Diane C. Lade
Staff writer
Posted September 30 2003

Seniors on Medicare increasingly are being forced to make tough decisions as 
their out-of-pocket medical expenses
continue to rise. Now they'll face one more: whether to drive to the nearest 
hospital for rehabilitative therapies they
might need, pay for it themselves or do without.

On Monday, a federal district court judge in Washington, D.C., turned back a 
legal attempt by consumer advocates to
block a cap on Medicare reimbursements for speech, occupational and physical 
therapies. The federal government now can
place a $1,590 annual limit on physical and speech therapies, with a separate 
$1,590 annual limit for occupational
therapy, beginning with    carereceivedSept.1.

That means Merle Marram, 67, already has received all of her Medicare-covered 
visits from her therapist this year. The
Lake Worth retiree, who suffers from lupus, had a knee replacement in June and 
was getting three at-home treatments
weekly.

Marram said she had no idea she had reached the limit on her benefit until her 
therapist called her last week, telling
her the next day's session would be the last covered. Now she has a choice of 
going to a local hospital for treatments,
as hospital-based therapies are not included in the cap, or paying out of her 
pocket.

"I guess I'll just have to see how it goes," said Marram, who must use a cane. 
She has trouble driving, so it might be
difficult for her to use a hospital program.

But her sympathy is for seniors who are dealing with strokes or Parkinson's 
disease, as they often need intense therapy
just to be able to talk or walk across a room. "This is going to kill them," 
she said.

Robert M. Hayes, president of the Medicare Rights Center, thinks Congress 
eventually will repeal the therapy limit,
which surfaced as part of the 1997 Balanced Budget Act. The center, along with 
Easter Seals and the American Parkinson
Disease Association, brought the lawsuit against the federal government.

House and Senate conferees working on the Medicare bill that addresses 
prescription drug coverage already had agreed to
include language again delaying the cap until 2005. Federal legislators in both 
houses have said they would sponsor
legislation repealing the cap permanently, Hayes said.

But the prescription drug coverage bill is moving slowly, and Congress doesn't 
want to introduce stand-alone Medicare
legislation while it's still in the works, Hayes said. "How many people will 
lose their chance at mobility, or never
come back from a stroke, while the congressional leadership sits on its hands?" 
Hayes asked.

Congress approved a series of moratoriums over four years, delaying the cap's 
implementation but never repealing it
outright. But Congress took no action this year, and therapy limits were to 
begin J uly1.

Medicare Rights and the other consumer groups then sued, saying that the 
Centers for Medicare and Medicaid Services
could not impose the limits without first notifying Medicare's 40 million 
elderly and disabled beneficiaries. The
parties reached a settlement, delaying the implementation to Sept. 1 with the 
federal government agreeing to contact 90
percent of Medicare recipients.

Federal Judge Emmet Sullivan ruled Monday that Medicare had kept its end of the 
deal. However, he did say individual
beneficiaries could challenge coverage denials if they weren't notified of the 
cap, according to Hayes.

Bill Shearouse, a partner in Alternative Rehab of West Palm Beach, and other 
therapy providers have created the
American Rehab Foundation in order to challenge the cap. Shearouse, whose 
clients included Marram, said the foundation
is considering suing the federal government on the grounds it has discriminated 
against small businesses by not capping
therapy reimbursements for hospitals and their outpatient clinics.

"Providers are upset about what this is doing to our patients," Shearouse said.

Diane C. Lade can be reached at dlade@xxxxxxxxxxxxxxxx or 561-243-6618.

SOURCE: The South Florida Sun-Sentinel


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