Your Therapy Allowance is Shrinking, Healthcare Reform Already!

Long term care residents started fresh this year with their
annual allowance for therapy on January 1, 2010. This is due to the
expiration of Medicare Part B therapy exceptions. The spending limits
are $1,860 for combined speech and physical therapy, and $1,860 for
occupational therapy. But how long will the allowance really last? If,
however, healthcare reform should pass, it would extend the therapy caps
exceptions process.

When a resident exhausts the therapy benefit, it causes a
problem for the resident who needs the therapy and the nursing home
which provides it. The options the residents have are not very appealing
but they include: the resident privately funding the therapy; the
facility could continue to provide the therapy with the expectation it
will be reimbursed when the bill passes; or it could altogether suspend
the therapy. Another option is to send a resident to a hospital
outpatient facility where there is no limit on the therapy because
Hospitals are not subject to the therapy caps rule. However, there can
be many problems transporting residents who may be frail or unwilling.
The resident who most likely would feel the impact of the allowance cap
would be someone who suffered a high-acuity event, such as a stroke or
hip or knee replacement, and needs intensive, short-term therapy.

Although there is no cause for alarm just yet, with each day
that passes residents and nursing homes are stuck with the dilemma of
what happens next. At this point it seems that the best option for
residents in need of regular therapy is for Congress to pull together
and pass the healthcare bill. As each day passes, the health needs of
residents are depending on it. Some are optimistic in swift action by
Congress, such as Peter Clendenin, executive vice president for the
National Association for the Support of Long Term Care, stating "I think
they'll [Congress] get to it early this month, but we're sort of hanging
out there until that gets done." The Senate bill would extend the
exceptions process for one year, while the House bill would extend it
for two.

Thus, whether or not you are a fan of healthcare reform,
this is at least one reason you may consider supporting it.

Michael Khalili

mwk@knudsenlaw.com

www.knudsenlaw.com