Maintenance therapy in Medicare
Medicare settlement update:
On January 24, 2013, a US District Court judge approved a settlement in Jimmo v. Sebelius, a case brought by the Center for Medicare Advocacy arguing that Medicare had illegally subjected beneficiaries to an “improvement standard” for rehabilitation therapies.
The improvement standard resulted in rehabilitation therapy being denied for millions of people with disabilities, on the grounds that their condition was stable, chronic, not improving, or that the necessary services were for maintenance only.
The illegal use of an improvement standard has been an ongoing concern for the paralysis community and we were excited to hear of the judgment.
With this ruling, if a patient needs skilled care and he or she meets the other requirements for Medicare coverage, that patient will be covered, regardless of whether or not the patient's condition is improving.
This will have an extraordinary impact on the disability community, providing significant financial relief and necessary services that patients might not receive otherwise.
The Reeve Foundation has joined the Center for Medicare Advocacy's Jimmo Implementation Council. This group of advocates will help the Center monitor the implementation of the decision and ensure that Medicare is providing the rehabilitation therapies to which beneficiaries are entitled.
Our information specialists have been trained on the Jimmo decision, and are ready to help if you have questions about your therapy coverage in Medicare.