Resolution Adopted
by the CCAR
MEDICARE
ANNUAL CAP ON REHABILITATION SERVICES
Resolution adopted at the 111th Convention of
the
Central Conference of American Rabbis
March,
2000
Background
The Jewish
textual tradition unquestionably demands that we show special concern
for the welfare of the elderly. The Holiness Code of Leviticus
declares that we must “rise before the aged and show deference to the
old,” (Lev. 19) and the Psalmist pleads “cast me not away in my old
age.” It goes without saying that the torah equates zeqenim,
elders, with those worthy of our attention and respect.
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.