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. But how long will the allowance really last? If, however, healthcare reform should pass, it would extend the cap’s exceptions process.

When a resident exhausts the 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 treatment; 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 treatment.

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