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Health - Medicare Medicare - Constituent Notice Limited Help for the Physical Therapy Cap A number of constituents have contacted my office recently to ask about the cap for physical therapy treatments reimbursed by Medicare. The moratorium on the cap for physical therapy coverage expired on December 31, 2005 and Congress did not extend the moratorium. As a result, there was a provision that set a limit of $1740 for treatment for physical therapy and occupational therapy. I was very concerned about this new limitation of coverage and voted against its implementation. I am relieved to report that the Centers for Medicare and Medicaid Services (CMS) has just created therapy cap exceptions for certain medically necessary services provided on or after January 1, 2006. The exceptions process allows for two types of exceptions to caps for medically necessary services, an automatic exception and a manual exception. Until providers who contract with CMS are able to implement the exceptions process, they are required to accept requests for adjustment of claims for services in 2006 that were denied for exceeding the caps. Moreover, the law mandates that if CMS does not make a decision within 10 days, the services will be deemed to be medically necessary. Under the law, the exception process is only available for services provided during 2006. I have a continuing concern about whether the moratorium will be extended beyond 2006 and will continue to fight for it in the future. I have attached a fact sheet from CMS that describes the exceptions process that I hope you find helpful. I understand that this issue is of great importance to you and wanted to share the limited help that CMS has offered for the physical therapy cap. If you have any questions about this process, please do not hesitate to contact my district office for assistance. Medicare Part D Prescription Drug Coverage I have received many calls regarding the problems constituents have experienced regarding Medicare’s new prescription drug plan, Part D. Constituents who call my office have had a wide range of problems that include: the inability to fill prescriptions, difficulty understanding which medications are and are not covered by a plan, problems with enrollment, or they have been unable to talk to Medicare or their insurance companies by phone. My district office staff has been contacting Medicare to provide guidance to my constituents and to assist in resolving their concerns. If you are experiencing a problem with Medicare, please contact my district office for assistance. Rep. Waxman's District Office in Los Angeles Introduction | Statements and Letters | CRS Reports | Helpful Links | Member Reports |
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