The Center for Medicare Advocacy is launching a new advocacy and education initiative to eliminate the Medicare “Improvement Standard,” which requires that Medicare beneficiaries be able to improve in order to qualify for coverage. The insistence that people must be able to get better unfairly restricts access to Medicare coverage and necessary health care.

Although the Improvement Standard conflicts with the law, it has become deeply ingrained in the system and ardently followed by those who provide care and those who make coverage determinations throughout the health care continuum. Beneficiaries are told Medicare coverage is not available if their underlying condition will not improve, if they have “plateaued,” are not likely to improve, or if they need “maintenance care only”.

As a result it keeps people with debilitating, chronic conditions from receiving the care they need. This practice persists although the Medicare Act does not require improvement as a precondition to coverage for illness or injury. Further, the federal regulations state that “restoration is not to be the deciding factor” in making Medicare coverage determinations.

Everyday the Improvement Standard blocks access to Medicare and health care for real people. The people most affected by this barrier include people with Multiple Sclerosis, Alzheimer’s disease, ALS (Lou Gehrig’s disease), spinal cord injuries, diabetes, Parkinson’s disease, hypertension, arthritis, heart disease, and stroke. Further, the erroneous standard disproportionately affects people who have low-incomes, as well as African-Americans and Hispanics.

With support from The Atlantic Philanthropies, the Center for Medicare Advocacy will begin a focused, collaborative effort to eliminate the Improvement Standard in Medicare policy and practice. This effort will include advocacy with the administration, litigation if needed, and a multi-faceted education campaign.

Email [email protected] if you or someone you know has had problems obtaining Medicare coverage, necessary health care, or rehabilitative services because the patient was said to be chronic, stable, not likely to improve, or in need of “maintenance services only”.
The Center for Medicare Advocacy
Advancing Fair Access to Medicare and Health Care
PO Box 350
Willimantic, Connecticut 06226
(860) 456-7790