Alisa,

I remembered my sister (an OT) telling me something about this.  My understanding is that there was a new ruling that is allowing maintenance to be a goal that can qualify someone for therapy. 

Here is a link that may help:
http://encompassmedicare.com/new/wp-content/uploads/2013/12/MM8458_Jimmo.pdf

I think this issue is that maintaining function is now considered a valid goal - vs showing some sort of improvement.  Will this allow someone to get therapy indefinitely, I do not know, but it does appear to open the window for PALS to get home therapy (and home health care) for longer periods of time.

Sincerely,
 
Antoinette Verdone, MSBME, ATP
Owner, Rehabilitation Engineer
ImproveAbility, LLC
Office: 512-522-1705
Cell: 512-497-6026
Email: xxxxxx@improveability.com
Web: www.improveability.com
Fax: 888-501-1009
Address: 7301 Burnet Rd, Suite 102-265, Austin, TX 78757
 
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-------- Original Message --------
Subject: PT/OT services via Medicare
From: Alisa Brownlee <xxxxxx@alsa-national.org>
Date: Mon, March 02, 2015 3:52 pm
To: Undisclosed recipients:;

 
One of the docs at our clinic has a question that I am hoping someone in the group can answer
 
There is info going around to neuromuscular docs saying that people with ALS can get skilled care at home for PT and OT indefinitely with the diagnosis of ALS through some new Medicare legislation. Is this true?
 
The response from one of our social workers:
 
This is the second email we've received asking about this.  We contacted Bayada to see what their stance is.  They were going to investigate and get back to us.

Medicare DOES pay for medically necessary part time intermittent Home Healthcare that includes up to 35 hours per week of Home Health Aides. The patient must be receiving part time intermittent skilled services (ie PT, OT, SLP, nurse, etc) in order to receive home health aide services. PT is an important skilled service for a patient throughout the duration of living with ALS.

Terminally diagnosed patients would be on a "maintenance program" versus a rehab/improvement program.

There is no limit on duration for how long they can receive these part time intermittent skilled services as long as they are medically necessary.

Important Links:

Available Homecare benefits coverage paid by Medicare:
http://www.medicareadvocacy.org/medicare-info/home-health-care/

Jimmo impact resulting in Homecare Benefits for those with a terminal diagnosis:
http://www.medicareadvocacy.org/medicare-info/improvement-standard/



MY QUESTION TO THE GROUP—anyone have any experience with this type of service?  Can our folks get indefinite services?? Any insight appreciated as we are having a difficult time getting a straight answer.
 

Alisa

Alisa Brownlee, ATP
Manager, Assistive Technology Services
ALS Association Greater Philadelphia Chapter and National Office Direct phone line: 215-631-1877 Office cell: 610-488-2988 ________________________________________
From: Elman, Lauren [xxxxxx@uphs.upenn.edu]
Sent: Friday, February 27, 2015 5:21 PM
To: Kelley, Mary; Alisa Brownlee
Subject: FW: New Reply - ALS and home health aids


Alisa
 
Alisa Brownlee, ATP
Manager, Assistive Technology Services
ALS (Lou Gehrig’s Disease) Association, National Office and Greater Philadelphia Chapter
 
Office line: 215-631-1877
Business Cell: 610-488-2988
 
Twitter: alsassistivetec
Facebook: Alisa Brownlee ALS