Medicare and the Improvement Standard
What is the Improvement Standard?
Up until 2013, the improvement standard was a policy within Medicare that required Medicare beneficiaries to show improvement to continue receiving physical, occupational, and speech-language therapy services. This meant that for people with diseases that did not improve, such as Parkinson’s, coverage of therapy services could be denied despite the benefits provided.
What did PAN do to Change the Policy?
In 2011, the Parkinson's Action Network (PAN) joined a class action lawsuit against the Center for Medicare and Medicaid Services (CMS) over a standard for Medicare coverage that we believed discriminated against people with Parkinson's and other chronic degenerative diseases.
In the lawsuit, known as Jimmo v. Sebilius, the Center for Medicare Advocacy (CMA) and Vermont Legal Aid represented PAN, the National Multiple Sclerosis Society, the Paralyzed Veterans of America, the Alzheimer’s Association, the National Committee to Preserve Social Security and Medicare, and four Medicare patients. The plaintiffs argued that the standard required Medicare beneficiaries to show improvement to continue physical, occupational, and speech-language therapy services. For a degenerative disease like Parkinson's, therapy is not a cure, but it is a treatment option that can improve quality of life and help maintain independence.
A settlement was reached in January 2013, and CMS was given one year to update its policy manual as well as develop and implement a nationwide education campaign for all who make Medicare determinations. Unfortunately, while the policy manual has been updated, confusion remains and people are still being denied coverage.
In order to aid people with Parkinson’s and other diseases, PAN has pulled together the following educational materials to help:
- PAN One-Pager on the Improvement Standard
(Also includes information about Medicare therapy caps)
- CMS Summary of Changes
- CMS Webinar on Improvement Standard–Audio & Presentation Slides
- CMA Self Help Packets
- American Physical Therapy Association Resources (APTA)
- American Speech-Language-Hearing Association Article (April 2013)
- APTA's "Understanding Jimmo v. Sebelius" Postcast - Transcript & Audio
There have also been several news articles written on the improvement standard that you might find helpful:
- A Quiet ‘Sea Change’ in Medicare
New York Times | March 25, 2014
- New Medicare Coverage of Long-Term Care off to a Rocky Start
Reuters | April 29, 2014
- Navigating Medicare Policy on Physical Therapy and Other Services
New York Times | May 29, 2014
- Take Action
- Affordable Care Act
- Congressional Caucus
- Data Collection on PD
- Department of Defense
- Food and Drug Administration
- National Institutes of Health
- Social Security Disability
- Veterans Affairs
- Other Initiatives