Cap on therapy services lifted for Medicare beneficiaries

Posted at 5:37 PM, Mar 07, 2018
and last updated 2018-03-07 23:09:39-05

Carlos Hamilton Sr. struggles with chronic pain in his knees. He hurt them decades ago while he was serving our country. He said he hasn't been the same since.

"I can't move in the morning. When I get up out of bed, I can't move until both of the knees pop. You can hear them when they pop," Hamilton said.

His mornings are rough, but his days are getting easier with weekly visits to Centex Rehabilitation in Harker Heights.

"I want to get back to being normal like I was when I first joined the military," Hamilton said. "I won't get back to running miles under 12 minutes again, but just being able to run a mile would be good."

On Jan. 1, Hamilton was told his progress may come to a halt after Medicare placed a $2,010 cap on outpatient therapy services.

Jason Miller owns Centex Rehabilitation. He said 40 percent of his patients have Medicare and many of them are living off a fixed income, unable to pay the cost of their treatment out of pocket. 

"If you run out of services, if you run out of money for what's allowed for it, you're done," Miller said. "If we have to cut that off, it's just a horrible feeling. We want them to be 100 percent better. We want them to get back to doing what they were supposed to be doing. Playing with their grandkids, working, doing the things they love."

Thankfully, the limit didn't last long. It was lifted at the beginning of February when President Donald Trump signed into law a budget bill that included a repeal of the cap.

Hamilton was relieved to hear of the change.

"I felt really good that I could stay local here and get the treatment that I need, instead of going back to the VA and taking an appointment away from somebody who needs it there," Hamilton said.

Now those working to get better can keep their eyes on the prize without worry about their finances.

"It's a part of life," Hamilton said. "I want to live a little bit better than I am now."

The American Occupational Therapy Association found that nearly six million people on Medicare got outpatient therapy services in 2015.

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