Advocates Say: Medicare Still Not Complying With Therapy Ruling - Blog - Reeve Foundation

Disability and health care advocates are continuing to push Medicare to provide more therapy services.

On March 1, 2016 the Center for Medicare Advocacy (CMA) filed a motion in court, claiming that the federal Medicare office (the Centers for Medicare and Medicaid Services or CMS) has not complied with the ruling in Jimmo v. Sebelius and continues to deny therapy coverage on an “improvement standard.” In 2012, CMA previously sued Medicare on the basis that people were being denied Medicare therapy services because they were not “improving.” Medicare law does not require “improvement,” but also covers therapy to maintain an individual’s condition or slow deterioration. The judge ruled in the advocates’ favor, and ordered Medicare to change its practices.

Unfortunately, Medicare providers and contractors continue to illegally deny Medicare coverage today based on this false “improvement standard.” CMA returned to court, arguing that Medicare has not done enough to educate providers and contractors about the policy or the court’s decision.

“We are returning to the Court to ask for relief that CMS has refused to provide,” said Gill Deford, Director of Litigation for the Center for Medicare Advocacy, and lead counsel for the plaintiffs. “For over two years, we have tried repeatedly to get Medicare to take additional steps to make sure that providers and contractors knew that the days of using an Improvement Standard test have ended but the agency would not do anything. We’ve provided overwhelming evidence that providers and contractors were not educated about the Settlement Agreement and that Medicare beneficiaries were still having their coverage terminated.”

The Reeve Foundation assisted the CMA in collecting stories on when and where coverage was denied for individuals living with paralysis. Our team of information specialists has also been trained specifically in the Jimmo v. Sebelius decision and is ready to assist you to navigate the process of gaining access to more care if your therapy was denied on this illegal “improvement standard.”