A corrective statement to clarify Medicare coverage of therapy delivered in a skilled nursing facility or in the home setting was approved recently by a federal court. The statement, to be used as part of the settlement in the Jimmo v. Sebelius case, is designed to clearly explain that therapy to maintain a person's condition or slow down his or her decline is covered under Medicare.
According to a McKnight's article, attorneys at the Center for Medicare Advocacy (CMA) "were pleased with the statement's emphasis on maintenance coverage availability." The CMA update regarding the corrective statement emphasized its purpose "to affirmatively disavow the use of an 'Improvement Standard' for Medicare coverage."
However, they also advised beneficiaries and providers to be aware that settlement standards are in effect now, even as the Centers for Medicare and Medicaid Services rolls out its education campaign. CMA said it is "hearing from beneficiaries who are still being denied Medicare coverage based on an Improvement Standard," and encouraged people to appeal if they are denied coverage for therapy services because they are not improving.
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