Medicare Finalizes Removal of Improvement Standard

The Centers for Medicare and Medicaid Services (CMS) took an important step to remove the improvement standard by releasing updates to the policy manual, which clarifies that Medicare beneficiaries can no longer be denied coverage for physical, occupational, and speech-language therapy services solely for lack of improvement. The policy manual is used by Medicare contractors in determining coverage of services. The effective date of these changes is January 7, 2014.

In 2011, PAN joined the Center for Medicare Advocacy and other patient advocacy groups, in filing a class action lawsuit against CMS over a standard for Medicare coverage that we believed discriminated against people with Parkinson’s and other chronic degenerative diseases. The standard, commonly referred to as the Improvement 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 for people living with the disease.

The lawsuit reached a favorable settlement in January 2013, and CMS was given one year to update the policy manual as well as develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve. PAN is pleased to see the end of this discriminatory standard and is dedicated to ensuring people with Parkinson’s have access to medically necessary physical, occupational, and speech-language therapy services. To learn about PAN’s other efforts in this area, click here.

Read a summary of the updates here


Date originally posted: December 13, 2013.