CMS agrees to correct mistakes on Medicare therapy standard in court decision
A federal judge in Vermont has approved a CMS plan to correct a misconception that Medicare beneficiaries are only eligible for physical and occupational therapy if their health is improving.
Kaiser Health News reports a 2013 effort to re-educate providers on the Improvement Standard hasn’t worked, with seniors still being denied coverage when they’re deemed to have reached “a plateau” in their therapy.
The new settlement will include a simple explanation from CMS that improvement is not part of the criteria for coverage and clarifying “that the Medicare program will pay for skilled nursing care and skilled rehabilitation services when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met).”
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John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.