Statement by APTA President on Settlement of Medicare 'Improvement Standard' Class Action Lawsuit

February 8, 2013

The American Physical Therapy Association (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. 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.

APTA has long believed that every patient has the right to receive medically necessary physical therapist services regardless of diagnosis, condition or illness. The ability to improve should never be the sole determining factor in deciding whether or not a patient receives the skilled services of a physical therapist. The final settlement resulting from this suit reinforces that important principle, and we will work diligently to support and promote consistent and fair application.

As part of the injunctive provisions set forth in the final settlement agreement, CMS is directed to revise its Medicare Benefits Policy Manual (MPBM) to set a maintenance coverage standard and also 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. We also plan to work with other health care providers to ensure that patients are not being unfairly denied medically necessary physical therapist services based on an arbitrary "improvement standard."

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. We strongly believe the needs of the patient should always come first and are encouraged by the final outcome of this suit. It will ensure that millions of Medicare patients across the country will have access to high quality physical therapist services.

APTA President Paul A. Rockar Jr, PT, DPT, MS