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- Written by Susan Jaffe Susan Jaffe
Physical therapy helps Leon Beers, 73, get out of bed in the morning and maneuver around his home using his walker. Other treatment strengthens his throat muscles so that he can communicate and swallow food, said his sister, Karen Morse.
But in mid-January, his home healthcare agency told Morse it could no longer provide these services because he had used all his therapy benefits allowed under Medicare for the year.
Beers, a retired railroad engineer, has a form of Parkinson’s disease. The treatments slow its destructive progress and “he will need it for the rest of his life,” Morse said.
But under a recent change in federal law, people who qualify for Medicare’s therapy services will no longer lose them because they used too much.
“It is a great idea,” said Beers. “It will help me get back to walking.”
The federal budget agreement Congress approved in February removes annual caps on how much Medicare pays for physical, occupational, or speech therapy and streamlines the medical review process.
It applies to people in traditional Medicare as well as those with private Medicare Advantage policies.
As of Jan. 1, Medicare beneficiaries are eligible for therapy indefinitely as long as their doctor — or in some states, physician assistant, clinical nurse specialist, or nurse practitioner — confirms their need for therapy and they continue to meet other requirements.
The Centers for Medicare & Medicaid Services has notified healthcare providers about the change.
And under a 2013 court settlement, they won’t lose coverage simply because they have a chronic disease that doesn’t get better.
“Put those two things together, and it means that if the care is ordered by a doctor and it is medically necessary to have a skilled person provide the services to maintain the patient’s condition, or prevent or slow decline, there is not an arbitrary limit on how long or how much Medicare will pay for that,” said Judith Stein, executive director of the Center for Medicare Advocacy.
But don’t be surprised if the Medicare website doesn’t mention the change. Information on the website will be revised “as soon as possible,” said a spokesman, who declined to be identified. However, information from the 800-Medicare helpline has been updated.
Until then, patients can refer to the CMS update posted for providers.
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. https://khn.org