Agencies sue over Medicare therapy reimbursements

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Rep. Jan Schakowsky (D-IL)
Rep. Jan Schakowsky (D-IL)
A Medicare reimbursement policy that some say denies chronically ill patients needed therapy services has recently come under fire in federal court. Five national organizations are suing the Department of Health and Human Services to have the policy repealed.

The suit was filed in U.S. District Court in Vermont by the National Multiple Sclerosis Society, Parkinson's Action Network, Paralyzed Veterans of America, National Committee to Preserve Social Security and Medicare, the American Academy of Physical Medicine and Rehabilitation and other organizations.

Current Medicare policy requires that a patient exhibit “demonstrable improvements” in order to qualify for skilled nursing care and physical, speech and occupational therapy. Because of this policy, certain chronically ill individuals, including stroke survivors, patients with Parkinson's disease and some accident victims, could be denied treatment that could help them remain independent, according to the plaintiffs.

“Thousands of Medicare patients have been denied coverage for skilled services such as home health care, physical, occupational and speech therapies because their underlying condition will not improve,” said Judith Stein, founder and director of the Center for Medicare Advocacy.

In a May 2010 letter to the Centers for Medicare & Medicaid Services, 17 Democratic congressmen, including Reps. Joe Courtney (D-CT), Barney Frank (D-MA) and Jan Schakowsky (D-IL), said the “elimination of the erroneous Improvement Standard in all care settings is vital to the health and well-being of millions of Medicare beneficiaries.”

Individual plaintiffs have successfully filed other similar lawsuits, but this is the first time national agencies have called the policy into question.