Should Medicare cover a person who continues therapy even when they are no longer making progress? This question has finally been answered with a resounding -yes!
For too long, many patients have been discharged from therapy services because their chronic disease or condition kept them from progressing in therapy even though they would still benefit from it.
In January, a federal judge ruled in favor with The Center for Medicare Advocacy regarding skilled maintenance nursing or therapy. Patients will no longer be denied therapy even though they are not making improvements.
The “Improvement Standard” lawsuit (Jimmo vs. Kathleen Sebelius) upheld a patient’s right to continue to receive ‘reasonable and necessary care to maintain their medical conditions and prevent or slow decline.’ The ability to improve no longer determines whether a patient can continue therapy.
The Center for Medicare and Medicaid Services is working on policy revisions and an education campaign to include the Settlement Agreement; however, the coverage of skilled maintenance services applies now for services in home health, nursing homes and outpatient settings.
This will impact not just the chronic conditions like MS, Parkinson’s, and Alzheimer’s, seen on snf, outpatient and home health caseloads, but could be significant impact for school based therapy providers as well.
For more information go to www.medicareadvocacy.org