New One Pager on Medicare Therapy Caps and Improvement Standard

In response to questions we have received about changes to Medicare coverage of therapy services, PAN has developed a one pager to clarify information about Medicare therapy caps and the improvement standard.

There is currently a combined $1,920 yearly cap for physical therapy and speech-language therapy, and a separate $1,920 yearly cap for occupational therapy. In 2006, Congress created an exceptions process for services deemed medically necessary to serve Medicare beneficiaries who need therapy services beyond the caps. As of now, the exceptions process is available until March 2015.

In 2011, 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, and other skilled 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. Effective January 7, 2014, Medicare beneficiaries can no longer be denied coverage for physical, occupational, and speech-language therapy and other skilled services solely for lack of improvement.

In addition to the one pager, PAN also updated our website to include more information and resources on therapy caps and the improvement standard.

To download and print the one pager, click here.

Please help us share this important information with others! Print it out and pass out at your support groups or let people know via social media. Here are two sample social media posts for you to use:

Questions about Medicare therapy caps or improvement standard? Get the facts w @PANTweets 1 pager: #parkinsons

The Parkinson’s Action Network has developed a one pager explaining the exceptions process for Medicare therapy caps and changes to Medicare’s improvement standard. Download it here: #parkinsons

If you have questions, please contact Catherine Pugh, government relations manager, at [email protected] or 202-638-4101 x101.

Date originally posted: June 20, 2014.