I have heard many stories over the years of families that fight to keep a nursing home resident getting physical, occupational, or speech therapy. It used to be that if there was a determination that a resident wasn’t progressing anymore, then Medicare or Medicaid did not pay, and the therapy was discontinued.
Many families were unhappy. Even though their mom or dad was not improving, the therapy was still beneficial – getting their resident moving or out of bed was simply good for them. They had to go through a lengthy appeals process.
Now however, after an important lawsuit filed against CMS, they are changing their policy. The New York Times reports that “[b]ecause of the settlement, the agency updated its policy manuals last year. The revisions make clear that if treatment is needed to prevent or slow further deterioration in a patient’s condition, ‘coverage cannot be denied based on the absence of potential for improvement or restoration.’ The update applies to therapy provided in nursing homes, in outpatient clinics and at home.”
This means that even if mom or dad is not improving but therapy is helping, they may be able to still get the therapy. This is good news for seniors and their families.
You can read the full article by clicking here.