Resolution Adopted by the CCAR

Effective January 1, 1999, Medicare began severely limiting coverage of non-hospital based (Medicare Part B) rehabilitation services. The Balanced Budget Act (BBA) of 1997 as interpreted by the Health Care Financing Committee (HCFA) placed an annual per beneficiary limit of $1500 on all Part B outpatient physical therapy and speech language pathology services; and a separate annual per beneficiary limit on all Part B outpatient occupational therapy services.

Due to what are believed to be technical reasons, HCFA had not been able this past year to implement the cap as intended by the BBA '97 and mandated instead that each provider keep track of the cap and not provide services to any beneficiary beyond $1500.

Providers of care to the elderly report that these artificial limits have proven to be drastically insufficient to care for our frail elderly population who can exhaust $1500 of physical therapy in two weeks during an acute episode.

The Balanced Budget Refinement Act of 1999, H.R. 3246 (BBRA '99) did not repeal the $1500 therapy cap but did place a moratorium on the cap. The moratorium is for two years starting with services provided on or after January 1, 2000 and running through December 31, 20001. Unless there is intervening legislation indicating otherwise, the $1500 cap will automatically be reinstated on January 1, 2002.

The BBRA '99 does provide for the development of a substitute for the therapy caps. It requires the Secretary to submit a report to Congress no later than January 1, 2001. The report must recommend a mechanism for assuring appropriate utilization of outpatient therapy and suggest an alternative payment policy for these services based on classification of individuals by diagnostic category, functional status and prior use of services.

The moratorium is a step in the right direction. During the past year, capitation of rehabilitation services penalized the frail, elderly and vulnerable among us. This is unconscionable in a nation as wealthy as the United States.

THEREFORE BE IT RESOLVED, that the Central Conference of American Rabbis commends Congress for placing a moratorium on the ill-conceived policy of limiting Part B annual coverage of physical and speech therapy to $1500 and of occupational therapy to $1500, and

BE IT FURTHER RESOLVED, that the CCAR requests that the cap for outpatient therapy services never be reinstated and that the Secretary's report to Congress recommend a policy that does not penalize people for their frailty and vulnerability.