• Friday, February 08, 2013RSS Feed

    APTA Issues Statement on 'Improvement Standard' Final Settlement

    "APTA is pleased with the decision of the federal court to approve the final settlement in the class action 'Improvement Standard' lawsuit (Jimmo vs Kathleen Sebelius), which upheld the right of patients to continue to receive reasonable and necessary care to maintain their medical conditions and prevent or slow decline," says APTA President Paul A. Rockar Jr, PT, DPT, MS, in a statement issued today. "We look forward to working with the Centers for Medicare and Medicaid Services (CMS) and its contractors to ensure the appropriate and equitable application of patient care as outlined in the settlement. We believe this final settlement reinforces the fundamental right established in the Medicare statute that affords patients the right to receive the services necessary to treat their diagnoses or illnesses."

    The final settlement directs CMS to revise its Medicare Benefits Policy Manual to set a maintenance coverage standard and launch a national educational campaign to explain the clarified benefit to its contractors, providers, and beneficiaries. "APTA is eager to serve as an active partner as the agency begins this work. Over the next several months, we will provide clinical and professional expertise to CMS to define appropriate treatment in accordance with our professional standards," Rockar says.

    While CMS works to publicize changes and new resources, APTA will actively educate members on how to give appropriate care as defined by this final settlement.


    Comments

    This ruling is so important for those who have been declined services and continue to decline rapidly without treatment. The frontlines of medical care have been redefined by the court. Amen
    Posted by Tom Brocato on 2/9/2013 8:18 AM
    This ruling is critically important for those with chronic disease. We can keep them on service and prevent complications and possibly unnecessary hospitalizations. Nothing could be better for our patients and the greater healthcare system.
    Posted by Sue O'Brien on 2/10/2013 7:31 PM
    I think it is important and at the same time amazing for us to realize that the "improvement requirement" has been an illegal rule of thumb created by many intermediaries or contractors. We as providers (most especially the new grads) have been bullied into believing this requirement was part of the "Medicare" rules or the Code of Federal Regulations. "Medicare" or more importantly the Code of Federal Regulations has never actually had an "improvement requirement." The Code of Federal Regulations actually supports the establishment and monitoring of a program by PT's. Sometime in the mid 80's the home health section printed a two part article from Edward Dale and an organization known as Legal Assistance to Medicare Patients (LAMP). Mr Dale taught us how to be advocates for our patients. Would be nice to see a reprint of this article on the APTA website. Thanks, Joseph M. Eschman PT, DPT, GCS
    Posted by Joseph Eschman on 2/12/2013 9:33 AM
    This is welcomed news! I hope there will be carry over to the private insurers who also deny visits as sooon as a patient's progress plateaus.
    Posted by Pat Marino, MA, PT on 2/12/2013 12:27 PM
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