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Medicare Therapy Coverage for Persons With Dementia

Medicare Therapy Coverage for Persons With Dementia
On January 24, 2013, a federal judge approved a settlement to the class-action lawsuit Jimmo v. Sebelius. The lawsuit challenged the Medicare Improvement Standard, which formerly prevented Medicare from paying for occupational, physical, and speech therapy services that help prevent decline in persons with dementia and other disabilities.

The new settlement overturns the Improvement Standard, and now requires Medicare to pay for therapy services that maintain a person’s current condition, or that prevent or slow further deterioration. Medicare coverage is now based on whether a person needs skilled care.

This legislation supports the foundation of Dementia Capable Care training, which is that therapists and other care providers must proactively serve those with Alzheimer’s/dementia by discovering individuals’ best ability to function. Trained therapists then develop maintenance programs to minimize decline and deterioration.

This wellness approach improves quality of life. In addition, according to Jennifer Hitchon, in-house counsel for the American Occupational Therapy Association (AOTA), “This settlement has the potential to lower costs, because it will enable people to stay in their homes longer. . . As patient decline is slowed, hospital admissions and readmissions will be reduced. This is great way to keep people out of institutions—this is a welcome policy shift and money saver.”

Resources
  • Read more about Medicare therapy coverage on AOTA.org.
  • Therapists, find out about therapy training and how it can empower you with skills to implement reimbursable maintenance programs that help persons with dementia to thrive.
 
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