Ever since Cindy Hasz opened her geriatric care management business in San Diego 13 years ago, she has been fighting a losing battle for clients unable to get Medicare coverage for physical therapy because they “plateaued” and were not getting better.
“It has been standard operating procedure that patients will be discontinued from therapy services because they are not improving,” she said.
(Paul O. Boisvert for The New York TimesGlenda Jimmo at home in Lincoln, Vt., in 2012. She was the lead plaintiff in a lawsuit over whether Medicare should pay for treatment for people whose underlying conditions were not likely to improve)
No more. In January, Medicare officials updated the agency’s policy manual — the rule book for everything Medicare does — to erase any notion that improvement is necessary to receive coverage for skilled care.
But don’t look for an announcement about the changes in the mail, or even a prominent notice on the Medicare website. Medicare officials were required to inform health care providers, bill processors, auditors, Medicare Advantage plans, the 800-MEDICARE information line and appeals judges — but not beneficiaries.
Ms. Hasz said she was shocked when she heard the news. “This is a sea change,” she said.
The manual revisions were required in the settlement to a class-action lawsuit filed in 2011 against Kathleen Sebelius, the secretary of health and human services, by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of four Medicare patients and five national organizations, including the National Multiple Sclerosis Society, Parkinson’s Action Network and the Alzheimer’s Association. The settlement affects care from skilled professionals for physical, occupational or speech therapy, and home health and nursing home care, for patients in both traditional Medicare and private Medicare Advantage plans.
“It allows people to remain a little healthier for a longer time and stay a little bit more independent,” said Margaret Murphy, associate director at the Center for Medicare Advocacy. And it eases the burden on families who “are scrambling to take care of their loved ones,” she said.
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