Medicare Improvement Standard Settlement Opens Coverage for Chronically Disabled

Law Firm Newswire



Waxahachie, TX (Law Firm Newswire) February 13, 2013 – Medicare has changed its standards to allow therapeutic services for conditions which previously had to “improve.”

The Parkinson’s Action Network (PAN), together with the Center for Medicare Advocacy, has filed a class action lawsuit against the U.S. Department of Health and Human Services. The lawsuit is asking that Medicare’s Improvement Standard measurement for Parkinson’s and other degenerative diseases be removed; Medicare has been accused of denying therapy services to patients when it was determined that their condition had not “improved.”

The administration, spurred by the class-action lawsuit, has agreed to alter the standard practice of requiring many beneficiaries to prove they would likely improve medically, or functionally, in order for Medicare to cover therapy and skilled nursing services.

The new agreement states that Medicare will approve those therapeutic services which will prevent, or slow a worsening of the identified condition, or to maintain the patient’s current condition. Medicare manual administrators are in the process of rewriting the manual to clarify coverage goals, to ensure that the coverage focuses on need, not improvement.

“The Settlement Agreement standards are being revised in educational material for administrators, so there may still be some confusion regarding the new policy,” said Dallas elder law attorney John Hale. “But individuals who need skilled maintenance care under Medicare should know that they are eligible for this coverage.”

Advocates say the proposed settlement benefits individuals with chronic conditions such as dementia, multiple sclerosis, and Parkinson’s disease, where slowing the progression of chronic and long-term conditions is often the foremost goal of therapeutic rehabilitation services, and evidence of medical improvement is often difficult or impossible to produce.

The Centers for Medicare & Medicaid Services (CMS) have been tasked with revising its Medicare Benefit Policy Manual, as well as a number of other policies, instructions and guidelines to make sure that “skilled maintenance services” are covered under Medicare in care settings, including in-home care, nursing homes and therapeutic outpatient offices.

CMS will also develop and implement a U.S. wide campaign to elucidate Medicare policy decisions so that Medicare beneficiaries, who have a chronic condition, continue to get coverage for treatments related to their condition, not predicated on any “improvement” matrixes.

The Center for Medicare Advocacy has released information to help clarify the proper coverage rules for the public and assist with appeals.

John Hale is a Dallas elder law attorney and Dallas estate planning lawyer with The Hale Law Firm. To learn more visit

The Hale Law Firm
100 Executive Court, Suite 3
Waxahachie, TX 75165
Call: 888.425.3911

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