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Legislation>>Model Letter for Patients on Lifting the Therapy Cap - 1/3/2007


The Honorable _______________
U.S. Senate/U.S. House of Representatives
Washington, DC 20510/20515

Dear Senator/Representative ___________________:

As a concerned constituent and a patient, I am writing to you about a provision that originated in the Balanced Budget Act (BBA) of 1997 that harmed senior citizens in 1999 and is doing so again effective January 1, 2006. This provision imposes an approximate annual limit of $1,740 on my outpatient therapy services next year. This limitation, or cap, affects therapy services provided in all Part B practice settings except for those furnished in a hospital outpatient department.

Congress has recognized the potential consequences of the therapy cap and on three separate occasions imposed a moratorium to prevent its implementation. Therefore, I urge you to take action once and for all to remove the cap on therapy services and prevent harm to Medicare patients like me.

Congress is well aware of the inherent problems with the therapy cap:

  • The arbitrary therapy cap (approximately $1,740 in 2006) will have a disproportionate impact on those Medicare beneficiaries who need therapy care the most - the oldest and the sickest - denying access to essential care for the most vulnerable Medicare population.
  • Beneficiaries who require services above $1,740 will be forced to seek that care in an outpatient hospital department - if one is available to them in their area - or face paying 100 percent of the cost of additional treatment out of their own pockets.
  • This arbitrary cap will limit access to necessary therapy if a patient has more than one episode of care for therapy in a year - not uncommon for Medicare beneficiaries. For example, if I have a knee replacement and receive $1,740 in therapy, and then suffer a stroke or some other condition that requires therapy care later in the same calendar year, Medicare will not cover those services if the $1,740 limit has already been reached.
  • Senators John Ensign (R-NV) and Blanche Lincoln (D-AR) have joined with Representatives Phil English (R-PA), Ben Cardin (D-MD), Roy Blunt (R-MO), and Frank Pallone (D-NJ) in introducing the "Medicare Access to Rehabilitation Services Act" (S. 438/H.R. 916). This legislation would repeal the arbitrary cap on therapy benefits once and for all. I strongly urge you to cosponsor this important legislation and actively work for its adoption as soon as possible this year. I don't want to suffer irreparable medical and economic harm because there is a cap on my therapy services.

Thank you for your consideration. I look forward to hearing of your support of the Medicare Access to Rehabilitation Services Act (S. 438/HR 916) and your action to repeal the therapy cap once and for all.


Your Name
Your Address

*Be sure to sign the letter and include your address so the member of Congress knows you are a constituent residing in his or her district.*

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