Medicare Update: No More Improvement Standard!

Policy Manual Change Effective Today
Effective today, January 7, Medicare beneficiaries can no longer be denied coverage for physical, occupational, and speech-language therapy services solely for lack of improvement.

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. 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 and help maintain independence.

The lawsuit reached a favorable settlement 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. This will help ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve.

If you or your therapist has questions about the policy manual changes, we suggest you review and discuss this CMS summary of the changes. To listen to a CMS webinar summarizing the changes, click here. Slides from the webinar are available here.

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.

Date originally posted:  January 7, 2014.