Improvement Standard is No More

On January 24, 2013, the federal district court in Vermont approved a nationwide settlement that affects many Medicare-covered individuals.

It had become routine for Medicare to stop paying for therapy (physical, occupational, and speech) if the individual was no longer showing improvement. The Center for Medicare and Medicaid Services (CMS), which administers the Medicare program, has agreed that the “improvement” standard was improper.

Therapy in a nursing home, in the individual’s own home, or delivered on an out-patient basis, may continue if it is needed to maintain the individual’s level of function. CMS is committed to revising its rules to emphasize the change, and to educating therapy providers throughout the country.

Posted in Blog, Older Adults.