Scrutinizing Medicare Coverage for Physical, Occupational, and Speech Therapy

Provision of Medicare-covered physical, occupational, and speech therapy services for seniors is a persistent source of confusion, reports Kaiser Health News . Services have been discontinued for some seniors because therapists said their progress was not significant. Others have been told that they reached a yearly limit on services and were ineligible for further care. However, Medicare does not mandate that seniors demonstrate improvement in order to receive ongoing therapy, and it does not restrict the amount of medically necessary therapy. All Medicare-covered therapy must be designated "reasonable and necessary to treat the individual's illness or injury," require the services of skilled professionals, and be subject to medical oversight. With ongoing improvement not a precondition for receiving services, claims from therapists that they can no longer help the individual due to a lack of improvement could give beneficiaries grounds for an appeal. Medicare Part A services entitle people with untoward events requiring hospitalization 100 days of rehabilitation at a skilled nursing community, while seniors who return home after hospitalization may receive therapy from a home health agency. Qualification is determined by a need for intermittent skilled services, and the beneficiary being substantially homebound. Each episode of home healthcare can last as long as 60 days and be renewed with a physician's authorization. Part B services also cover physical, speech, and occupational therapy in private practices, hospital outpatient clinics, skilled nursing communities, and people's homes.