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One of several important provisions tucked into the federal budget agreement approved by Congress earlier this year can improve the health of 59 million Americans who have Medicare, the federal health insurance program for older or disabled adults. 

Expands Medicare's coverage of physical therapy

The new budget deal removes annual caps on how much Medicare pays for physical, occupational or speech therapy and also streamlines the medical review process. It applies to people in traditional Medicare as well as those with private Medicare Advantage policies.  Previously, there was an arbitrary cap that limited patient's access to physical therapy without taking into consideration severity of the condition, multiple injuries and body regions, or even the number of surgical interventions. 

As of Jan. 1, 2018 Medicare beneficiaries are physical therapy indefinitely as long as their provider confirms their need for therapy, and they continue to meet other requirements.

It took many years and even a few court cases by patients that had chronic conditions to get this law passed. Under a 2013 court settlement, patients won't lose coverage simply because they have a chronic disease that doesn't get better.

"Put those two things together and it means that if the care is ordered by a doctor and it is medically necessary to have a skilled person provide the services to maintain the patient's condition, prevent or slow decline, there is not an arbitrary limit on how long or how much Medicare will pay for that," says Judith Stein, executive director of the nonpartisan Center for Medicare Advocacy.

In addition, the State of Illinois just passed legislation to allow access to physical therapy without a referral or prescription.  The law, effective August 16, 2018, permits direct access to physical therapists who can now promptly evaluate patients and determine a treatment plan without first having to submit a diagnosis for a health care professional’s approval, speeding the path to relief and healing.

“Physical therapy has been proven effective in treating joint pain and mobility issues,” Governor Bruce Rauner said. “Seeing a physical therapist promptly and starting a rehabilitative course of treatment quickly can reduce or eliminate the need for potentially addicting pain medications, and can reduce overall health care costs. This legislation is a win for everyone.”

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