Medicare Covers Services to Maintain Patient’s Condition

For many years, individuals seeking rehabilitative services, either in a care facility or at home, have struggled against the very common misconception that Medicare will only cover medical services and rehabilitation therapies if the patient is continuing to improve. 

New regulations from The Center for Medicare and Medicaid (CMS), which became effective in January, 2011,  clarified that Medicare will cover such therapies that are necessary to maintain an individual’s condition.  In other words, if the therapy is necessary to prevent the patient’s condition from declining, they do not need to demonstrate that they are improving. 

As reported in the Spring issue of the NAELA (National Academy of Elder Law Attorneys) News, those of us who advocate for  seniors must continue to advise our clients, and their service providers, that Medicare cannot legitimately deny coverage for physical therapy, occupational therapy, and the like for lack of “restoration potential.”

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