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REHABILITATION SERVICES FOR PARKINSON PATIENTS IN JEOPARDY!! In a rush to find savings in the Medicare program last year, Congress imposed arbitrary annual caps of $1,500 per beneficiary on all outpatient rehabilitation services except those furnished in a hospital outpatient department. The legislation, part of the Balanced Budget Act of 1997, has been interpreted by Medicare to establish two limits - a $1,500 cap for physical therapy and speech-language pathology services and a separate $1,500 cap for occupational therapy services. The limits become effective for services rendered on or after January 1, 1999. These limits on outpatient rehabilitation services will impact heavily on person suffering from Parkinson's disease for two reasons. First, there is increasing evidence that persons with Parkinson's disease who receive these services benefit considerably in their management of the disease, comfort and activities of daily living. Second, because Parkinson's disease is a chronic illness, the caps will by met on a regular basis early in the twelve month cycle. The limits are completely arbitrary and bear no relation to the medical condition of the patient nor the health outcomes of the rehabilitation services. There exists no medical or empirical justification for the caps. The caps are insensitive to the needs of patients and amount to health care rationing. What makes this situation particularly frustrating is the fact that there have been no Congressional hearings on reimbursement methodologies for outpatient rehabilitation providers in general or the $1,500 caps in particular. In comparison, multiple hearings were held on new payment mechanisms for skilled nursing facilities, home health agencies and managed care plans. Relief may be in sight if we all act quickly Several Congressmen and Senators have already introduced legislation that would correct this problem. They are Congressman Ensign and Senators Grassley and Reid in the Senate. Each of you who is either a Parkinson patient, caregiver, or friend of someone with Parkinson's disease needs to write your Congressman and Senators asking them to be a co-sponsor of the "Reinstatement of the Medicare Benefit Act of 1998". A sample letter follows. If you need help identifying your Representative and/or Senators, or have any questions, please contact the NPF Washington Office, toll free @ (888) 331-4673. Bill Turenne or I will be happy to help you. If you are writing your Senators address the letter as follows: The Honorable (first and last name) United States Senate Washington, DC 20510 If you are writing your Congressman address the letter as follows: The Honorable (first and last name) United States House of Representatives Washington, DC 20515 SAMPLE LETTER Dear (CONGRESSMAN OR SENATOR) As a Medicare beneficiary and recipient of physical, occupational and speech therapy, I recently learned that starting January 1, 1999, there will be an arbitrary cap on the amount of outpatient physical therapy, occupational therapy and speech therapy services that I can receive from my therapist. Due to a provision in the 1997 Balanced Budget Act, I understand that Medicare will only cover $3,000 per year for all of these services in outpatient settings limiting me to treatment in outpatient hospital departments. As your constituent, I am upset that Congress has arbitrarily limited my options for care. While I understand that everyone should share in the burden to reduce Medicare costs to ensure solvency of the program, this arbitrary cap does not make sense. Optional--[Add patient history, particularly the benefits of these therapies to patients suffering from Parkinson's disease. Indicate how theses therapies have improved your functions, independence and activities of daily living..] I ask you to support the enactment of H.R. 3835, the "Reinstatement of the Medicare Rehabilitation Benefit Act of 1998" sponsored by Congressman John Ensign and a similar bill sponsored in the Senate by Senators Grassley and Reid. Sincerely,