APTA continues to make progress, through recommendations to commercial and other nonfederal payers, to eliminate what's often referred to as the "improvement standard"—the potential for improvement as a condition of coverage for skilled therapy services.
This so-called standard was called out in the 2013 Jimmo v Sebelius ruling that clarified Medicare's longstanding policy of covering skilled therapy services based on the need for skilled care, regardless of the presence or absence of a beneficiary's potential for improvement.
APTA's recommendations support payment for services requiring the skills of a physical therapist or physical therapist assistant to ensure that a patient doesn't experience an avoidable decline in function even if improvement is not anticipated. APTA will continue to work with commercial payers to promote adoption of policy changes that improve access to medically necessary services and promote the role of physical therapy in the prevention of functional decline.
The following payers have adopted language and or revised policies to remove the improvement standard or to cover maintenance therapy. Implementation and the extent of the benefit vary by payer.