Tag: Jimmo v. Burwell

Judge Accepts Medicare’s Plan To Remedy Misunderstanding On Therapy Coverage

By Susan Jaffe  | Kaiser Health News | February 3, 2017 | This KHN story also ran on     

A federal judge has accepted Medicare’s plans to try once more to correct a commonly held misconception that beneficiaries’ are eligible for coverage for physical and occupational therapy and other skilled care only if their health is improving.

“Confusion over the Improvement Standard persists,” wrote U.S. District Court Chief Judge Christina Reiss in Vermont in a decision released by the court Thursday. Advocates for seniors say coverage is often mistakenly denied simply because the beneficiary reaches “a plateau” and is no longer making progress.[Continued at Kaiser Health News and NPR]…

Medicare’s Coverage Of Therapy Services Again Is In Center Of Court Dispute

By Susan Jaffe  | Kaiser Health News | January 30, 2017 | This KHN story also ran on     

Four years after Medicare officials agreed in a landmark court settlement that seniors cannot be denied coverage for physical the
rapy and other skilled care simply because their condition is not improving, patients are still being turned away.

So federal officials and Medicare advocates have renewed their court battle, acknowledging that they cannot agree on a way to fix the problem. Earlier this month, each submitted ideas to the judge, who will decide — possibly within the next few months — what measures should be taken.

Several organizations report that the government’s initial education campaign following the settlement has failed. Many seniors have only been able to get coverage once their condition worsened. But once it improved, treatment would stop — until they got worse and were eligible again for coverage.

Every year thousands of Medicare patients receive physical therapy and other treatment to recover from a fall or medical procedure, as well as to help cope with disabilities or chronic conditions including multiple sclerosis, Alzheimer’s or Parkinson’s diseases, stroke, and spinal cord or brain injuries. [Continued at Kaiser Health News and NPR] …