According to a revised Medicare policy that went into effect in January of this year, Medicare beneficiaries who suffer from chronic illnesses can now receive coverage for physical therapy, nursing care and other services even though their condition has “plateaued” or is no longer showing improvement. Previously, patients with conditions such as multiple sclerosis, Parkinson’s disease or Alzheimer’s disease were denied Medicare coverage for such services because their underlying illness could not be cured.

The change in policy is the result of a class action lawsuit filed in 2011 against Kathleen Sebelius, Secretary of Health and Human Services, on behalf of four Medicare patients and five national organizations. The suit, filed by the Center for Medicare Advocacy, Vermont Legal Aid, alleged that Medicare beneficiaries with chronic illness were denied coverage for needed services based on Medicare’s “improvement standard,” which required that beneficiaries show a likelihood of improvement in order to receive coverage for skilled care and therapy services.

As a result of the settlement reached last year, Medicare will now cover care from skilled professionals for physical, occupational or speech therapy, home health and nursing care that is required to maintain a patient’s condition and functionality and/or prevent it from getting worse. Evidence of improvement is no longer required. The settlement affects patients in both traditional Medicare and private Medicare Advantage plans.

The Center for Medicare Advocacy offers self-help materials for Medicare beneficiaries who need assistance in appealing a denial of coverage.

California residents can contact the Health Services Advisory Group of California for help.