This is a response from our Senator’s office. Hope it sheds some light.

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The physical therapy benefit is included in home health service for Medicare beneficiaries, including individuals with ALS. The only barrier to indefinite coverage is the therapy cap, which can be exceeded with an appeal (and again when a second threshold is met), but it does limit physical therapy services if the appeal can’t be met which is not likely to happen with  ALS patients.

 

Also, there is a bill in the House that would repeal the therapy cap.

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Nancy Mashberg, M.A.

FAAST Regional Coordinator

 

 

-------- 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