REHAB CAPS: Medicare Patients Want Restrictions Lifted
Hundreds of people attended a "town-hall meeting" Friday at HCFA to "gripe" about the 1997 Balanced Budget Act's caps on rehabilitative care and other nursing home issues, the Wall Street Journal reports. Opponents claim the $1,500 annual limit on physician and speech therapy and $1,500 annual limit on occupational therapy are "forcing some stroke victims in nursing homes to decide whether to learn how to walk or talk." Medicare Payment Advisory Commission Chair Gail Wilensky, who "generally favors containing costs," characterized the caps as "totally arbitrary and capricious." Faced with complaints from both seniors and the nursing home industry, legislators are attempting to rectify the situation. Sens. Charles Grassley (R-IA) and Harry Reid (D-NV) have introduced a bill that "would allow some people to exceed the caps, based on medical needs." And House Ways and Means health subcommittee Chair Bill Thomas (R-CA), who first sponsored the caps, is looking at ways to "ease" them. While lawmakers work out the legislative details, however, patient advocates and industry officials "want the caps suspended or, at the very least, two separate ones established for speech and physical therapy." Top Medicare official Robert Berenson said the Clinton administration is also looking for a fix, but that he is not "exactly sure ... how this will be translated into a remedy." He said, however, that federal regulations require nursing homes to provide residents "all necessary care, including therapy," regardless of their reimbursements. Industry officials remain "skeptical," and ask if it is "realistic to expect people to provide free care" (McGinley, 4/26).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.