Rehabilitation: Is “Improvement” Required For Coverage?

Posted by Reeve Staff in Daily Dose on October 13, 2015 # Advocacy and Policy

Expected “improvement” is NOT required to receive physical therapy and other skilled rehabilitation services in Medicare. The Paralysis Resource Center is here to help you learn your rights and when you may be eligible for more coverage.

In January of 2013, the Center for Medicare Advocacy (CMA) reached a settlement with the US Department of Health and Human Services in the case of Jimmo v. Sebelius. CMA brought the suit because Medicare was illegally denying services for people with disabilities and chronic conditions based on the expectation that therapy would not improve their functional ability. The Jimmo Settlement reiterates that improvement is not required to obtain Medicare coverage for skilled care for outpatient therapies like physical and occupational therapy, home health care, skilled nursing facilities, and, in some cases, inpatient rehabilitation hospitals.

Over the past year and a half, CMA and the federal Medicare office have worked together to change Medicare policy and educate providers that Medicare will provide coverage for therapies to help people maintain - or prevent the decline of – their functional ability. According to the CMA, “Coverage does not turn on the presence or absence of potential for improvement, but rather on the need for skilled care.” Unfortunately, people are still being denied services for which they are legally eligible in Medicare.

This summer, the Reeve Foundation joined the Center for Medicare Advocacy’s Jimmo Implementation Council. On the council, we will work with CMA to implement the settlement and ensure that people are aware that an “improvement standard” is illegal. We are here to help you learn about your Medicare coverage and help CMA and collect stories from our community when services are wrongly denied. In September, the Center for Medicare Advocacy held training for Paralysis Resource Center staff on the policy change so we can keep YOU informed about your rights in Medicare.

Are you being told you cannot receive therapy services because your functional ability will not improve? Get in touch with our team and learn about your rights to more coverage.