Medicare will cover ongoing in-home maintenance therapy sessions, as long as regular assessments confirm that skilled therapy is needed to prevent or slow decline in the patient’s condition.
When Janet*, a 76-year-old Nassau County resident with a progressive genetic disease, began suffering from repeated falls, she was referred by her physician for in-home physical therapy (PT) with VNS Health therapist Patty Vieira. As Janet gradually lost the ability to walk, Vieira continued to work with her. Now, eight months later, although Janet has become wheelchair-bound, Patty still visits her once a week to get her on her feet and take her through exercises to maintain strength and promote blood flow in her arms and legs.
“The goal of our PT sessions is to preserve and maintain Janet’s health and function as much as possible,” says Vieira. “Without regular therapy, there’s no question her condition would be deteriorating more quickly than it is.”
Janet’s weekly therapy sessions are possible because Medicare reimburses their cost. Until ten years ago, the Centers for Medicare and Medicaid Services (CMS) guidelines were frequently interpreted to mean that Medicare would pay for rehab therapy only so long as it was producing a measurable improvement. Since then, CMS has taken additional steps to make it clear Medicare will cover ongoing rehab therapy sessions, as long as regular assessments confirm that skilled therapy is needed to prevent or slow decline in the patient’s condition—as in Janet’s case.
Medicare’s coverage of maintenance therapy includes in-home sessions, if the patient can’t travel to an outpatient clinic. While this has always been the case, VNS Health Home Care has seen an uptick lately in demand for home-based maintenance therapy, according to Joe Gallagher, Director of Operation Support Services at VNS Health.
“The COVID-19 pandemic caused a lot of patients to shift from outpatient maintenance therapy to sessions in their homes,” reports Gallagher. “Since then, we’ve been getting more and more referrals for in-home maintenance therapy.”
To meet this rising demand, VNS Health has implemented a new training program to educate its rehab staff on maintenance therapy techniques. “The therapeutic goals for someone with a progressive neurologic disease are different from those of a hip replacement patient,” Gallagher explains. “Instead of looking for improvement, the idea is to construct a program that prevents or slows the loss of basic abilities, like being able to stand up safely.”
Even so, adds Gallagher, “For elderly or chronically ill patients, maintenance therapy can have a significant impact as far as supporting their overall health and lowering their hospitalization risk, so it’s actually saving Medicare money. There are so many Medicare recipients out there who could benefit from this approach—at this point, it’s really a matter of connecting them with care.”
* The patient’s name has been changed for privacy.