The Jimmo Settlement Could Help Priscilla’s Sister Continue Therapy
My sister, who has an Alzheimer’s diagnosis, has been refused continuation of PT by the home care provider…They have discharged my sister from PT saying they will tell caregivers the PT exercises to do but will not send a PT person to the house. She currently goes to the bathroom herself, and goes to the kitchen. I don’t want her to lose these abilities.Priscilla G., California
To help the home health agency understand that the PT can continue with Medicare home health coverage, Priscilla should refer to the Important Message About the Jimmo Settlement on the government’s official Medicare agency website, CMS.gov. This should help the agency know (and believe) that the therapy is coverable by Medicare and should be paid. As the CMS.gov statement states regarding therapy: “Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.”
- Provide the CMS.gov document and/or link to the home health agency, therapist, and other relevant providers.
- Suggest, in turn, that the provider continue the therapy and submit the CMS.gov information with a claim to Medicare for the services.