Access to Health Care
Access to health services and treatments is an important part of a patient's care. For those living with Parkinson's disease today, these factors directly impact symptom management and quality of life. The ability to see a specialist and to pay for medications and care impacts the course of an individual's disease. The Michael J. Fox Foundation (MJFF) supports policies that increase patients' access to health care services and improve well-being.
Principles for the American Health Care System
To ensure the Foundation's public policy efforts are in line with the patient perspective, particularly around health care reform, MJFF established a set of guiding principles. These tenets highlight key components our health care system must incorporate to provide patients with comprehensive care. As legislation affecting access to care is introduced, the Foundation will evaluate proposed bills through the lens of these patient-centered principles.
Telemedicine is the remote delivery of health care services and clinical information using telecommunications technology, including internet, cellular, wireless, satellite and telephone services.
Access to movement disorder specialists -- doctors who have additional training in Parkinson's disease -- is limited in certain areas of the country. Being able to see a physician using a computer, at home or in a local doctor's office, could improve care for those who cannot travel to a specialist. Studies have shown that telemedicine can reduce hospitalization and keep people living safely and independently for longer.
A bill to expand telemedicine services for individuals covered by Medicare was introduced in 2015 but did not make it out of committee. MJFF will continue to support legislation that increases the remote delivery of health care services for those with limited mobility.
Individuals living with Parkinson's disease may be eligible for certain government benefits such as Social Security, Medicare/Medicaid or disability services. MJFF will work with legislators to enact policy and establish programs that provide sufficient care and coverage for people with Parkinson's. The Foundation encourages patients and families to become familiar with these programs and know their rights.
Medicare Therapy Caps
The Balanced Budget Act of 1997 created limits, or caps, on the amount of outpatient physical, occupational and speech-language therapy a Medicare beneficiary can receive each calendar year. Once those amounts were reached, beneficiaries who required additional services in the calendar year were responsible for 100 percent of the cost. Previously, Congress created an exceptions process that allowed individuals to access therapy above the cap if the services were deemed medically necessary, but this process needed to be renewed by lawmakers every few years, creating uncertainty and the potential for coverage denials.
In February 2018, thanks in part to the advocacy efforts of the Parkinson's community, Congress made the exceptions process permanent, meaning people on Medicare can no longer be denied therapy if they need it to manage their health conditions.
Medicare Improvement Standard
Up until 2013, the "improvement standard" was an inaccurate policy being arbitrarily applied by Medicare providers, contractors and adjudicators that required beneficiaries to show improvement to continue receiving physical, occupational and speech-language therapy. For people with chronic degenerative conditions like Parkinson's, therapy is not intended to result in improvement; it's used to help maintain function and increase quality of life. Therefore, people with PD could be denied therapy services under this inaccurate "improvement standard."
The "improvement standard" was challenged by several patients and advocacy groups, including the former Parkinson's Action Network, in the case of Jimmo v. Sebelius. The parties reached a settlement in January 2013 declaring Medicare beneficiaries cannot be denied coverage for physical, occupational and speech-language therapy, as well as other select services (including skilled nursing facilities, inpatient rehabilitation facilities and home health), solely for lack of improvement. The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, was given one year to update its policy manual and execute a nationwide education campaign for all who make Medicare determinations. Unfortunately, while the policy manual has been updated, confusion remains and people are still being denied coverage. In Spring 2016, the parties returned to court to pursue further legal action to ensure the Jimmo settlement is fully and accurately implemented.
In February 2017, the court ordered CMS to execute a "corrective action plan" to ensure beneficiaries are no longer being denied coverage due to the "improvement standard." The plan includes: