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November 4, 2013

The Honorable Max Baucus
Chairman, Committee on Finance
United States Senate
219 Dirksen Senate Office Building
Washington, D.C. 20510

The Honorable Orrin Hatch
Ranking Member, Committee on Finance
United States Senate
219 Dirksen Senate Office Building
Washington, D.C. 20510

Dear Chairman Baucus and Ranking Member Hatch:

As organizations representing patients and consumers affected by the Medicare therapy caps, we are writing to express concern about the omission of a long-term solution to the therapy caps as part of the framework released by the Committee last week to permanently address the Sustainable Growth Rate (SGR). We call on the Committee to ensure that patients and consumers are not forgotten in the effort to fix Medicare payment for providers.

According to the Medicare Payment Advisory Committee (MedPAC), almost one million Medicare beneficiaries could see their access to therapy services discontinued if hard caps on therapy were in place. Preventing patients from continuing medically necessary therapy services can cause adverse health outcomes and delay or prevent patients from recovering to their fullest potential. Given that the SGR and therapy caps were created in the same bill in 1997, we feel that the Committee's work to find a permanent solution for SGR is also an opportune time to seek a long-term strategy to alleviate the pattern of yearly extensions that put patient access to medically necessary therapy services at risk.

As you know, Congress has acted 10 times to prevent the therapy caps from affecting access to therapy services. While passage of the therapy caps exceptions process has helped to reduce the risk of these services being discontinued, it does not provide a permanent solution for policymakers or those who depend on outpatient therapy to remain functional in their daily lives. If Congress does not come to agreement on a permanent fix for the SGR this year, the therapy caps exceptions process should be continued into 2014. However, the ultimate goal should be to repeal the Medicare therapy caps prior to the exceptions process expiration on December 31, 2013.

Though we understand the need to create a truly sustainable system for provider payment under Medicare, we believe it would be shortsighted not to ensure that those receiving therapy services be considered in the SGR package. If allowed to be fully enforced, the therapy caps will cause some beneficiaries to be denied care or be forced to delay necessary care, force others to assume higher out-of-pocket costs, and disrupt the continuum of care for many seniors and individuals with disabilities. Such a policy would present a major hurdle to beneficiaries receiving the critical rehabilitation care they require to deal with a condition such as Parkinson's disease, stroke, multiple sclerosis, spinal cord injuries or arthritis.

Your support for including a long-term solution for the therapy caps in the SGR package is greatly appreciated. We appreciate your leadership on this issue and willingness to ensure Medicare beneficiary access to therapy services.

Sincerely,

The ALS Association
American Heart Association/American Stroke Association
Arthritis Foundation
Brain Injury Association of America
Easter Seals
National Multiple Sclerosis Society
National Stroke Association
Parkinson's Action Network

cc: Members of the House Ways and Means Committee

 

The Honorable David Camp
Chairman, Committee on Ways and Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington, D.C. 20515

The Honorable Sander Levin
Ranking Member, Committee on Ways and Means
U.S. House of Representatives
1102 Longworth House Office Building
Washington, D.C. 20515

Dear Chairman Camp and Ranking Member Levin:

As organizations representing patients and consumers affected by the Medicare therapy caps, we are writing to express concern about the omission of a long-term solution to the therapy caps as part of the framework released by the Committee last week to permanently address the Sustainable Growth Rate (SGR). We call on the Committee to ensure that patients and consumers are not forgotten in the effort to fix Medicare payment for providers.

According to the Medicare Payment Advisory Committee (MedPAC), almost one million Medicare beneficiaries could see their access to therapy services discontinued if hard caps on therapy were in place. Preventing patients from continuing medically necessary therapy services can cause adverse health outcomes and delay or prevent patients from recovering to their fullest potential. Given that the SGR and therapy caps were created in the same bill in 1997, we feel that the Committee's work to find a permanent solution for SGR is also an opportune time to seek a long-term strategy to alleviate the pattern of yearly extensions that put patient access to medically necessary therapy services at risk.

As you know, Congress has acted 10 times to prevent the therapy caps from affecting access to therapy services. While passage of the therapy caps exceptions process has helped to reduce the risk of these services being discontinued, it does not provide a permanent solution for policymakers or those who depend on outpatient therapy to remain functional in their daily lives. If Congress does not come to agreement on a permanent fix for the SGR this year, the therapy caps exceptions process should be continued into 2014. However, the ultimate goal should be to repeal the Medicare therapy caps prior to the exceptions process expiration on December 31, 2013.

Though we understand the need to create a truly sustainable system for provider payment under Medicare, we believe it would be shortsighted not to ensure that those receiving therapy services be considered in the SGR package. If allowed to be fully enforced, the therapy caps will cause some beneficiaries to be denied care or be forced to delay necessary care, force others to assume higher out-of-pocket costs, and disrupt the continuum of care for many seniors and individuals with disabilities. Such a policy would present a major hurdle to beneficiaries receiving the critical rehabilitation care they require to deal with a condition such as Parkinson's disease, stroke, multiple sclerosis, spinal cord injuries or arthritis.

Your support for including a long-term solution for the therapy caps in the SGR package is greatly appreciated. We appreciate your leadership on this issue and willingness to ensure Medicare beneficiary access to therapy services.

Sincerely,

The ALS Association
American Heart Association/American Stroke Association
Arthritis Foundation
Brain Injury Association of America
Easter Seals
National Multiple Sclerosis Society
National Stroke Association
Parkinson's Action Network

cc: Members of the House Ways and Means Committee

 

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