Hey there! Kim here, excited to share with you an historic ruling that brings great news for persons with Alzheimer’s disease and related dementias (ADRD) and their families.
Last week, the federal class action lawsuit that challenged the Medicare Improvement Standard resulted in the determination that Medicare will pay for occupational, physical, and speech therapy services that maintain the current condition of a person with Alzheimer's disease, or that prevent or slow further deterioration.
As you know, Dementia Capable Care training can significantly help habilitate and support individuals and their families. As we strive to improve function for individuals with dementia and slow the progression of the disease, I am thrilled that as therapists, we are now further empowered to help people with Alzheimer’s disease at all stages to thrive.
Learn more here, and please join me in celebration of this historic ruling by sharing this exciting news!
Here’s a transcript of “Lawsuit Won! Therapy Reimbursement Claims for Dementia Patients Honored”:
Hi, Kim Warchol, president of Dementia Care Specialists and a proud occupational therapist here with you today to share a historic ruling.
As you know, we've been training occupational therapists and other therapists how to evaluate and treat people with Alzheimer’s disease for several years now. Now people with Alzheimer’s do have a chronic and progressive condition. However, there has been an opportunity for therapists to work with people with Alzheimer’s because in the Medicare Benefit Policy Manual, there is an opportunity for therapists to create a maintenance program, and this is a reimbursable service. However, there's also been a rule out there about what’s called "the need for improvement" or "Medicare Improvement Standard," basically saying that in order for therapists to get reimbursement for serving their patients, they must be able to significantly improve the "problem area" or improve the dysfunction. However, there was a federal class action lawsuit that was brought against Medicare that challenged the Improvement Standard. And today (October 26, 2012), there was a settlement that overturned this Medicare Improvement Standard.
So this is fantastic news. Basically what this means is that therapy is now going to have an even better opportunity to work with people with Alzheimer's and related dementias. It should give people with Alzheimer’s access to these therapists because of the overturning of this Medicare Improvement Standard. So now under this settlement agreement, Medicare will pay for services if they are designed to maintain the patient's current condition or to prevent or slow further deterioration. That is hot off the presses.
And you can find this information at the National Alzheimer’s Association website, which is www.alz.org.
So now that I’m done presenting you with those facts as best as I can, I just want to close by saying how thrilled I am to now have this ruling. We know that occupational, physical, and speech therapists who have this special training can significantly help habilitate—improve the level of function, slow the progression of the disease and the deterioration through our interventions—and this is absolutely necessary to help people with Alzheimer’s disease at all stages to thrive and to help support their families. So I am so pleased to share this hot-off-the-presses news with you, and I do hope that you'll share it with others. Thank you.