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Mrs. R contacted the Center for Medicare Advocacy about her husband, who has ALS, and was told his home health physical therapy was about to be terminated. While receiving physical therapy, Mr. R had reduced pain, allowing him to decrease pain medications, improved bowel function, and increased ability to clear airway secretions. Nonetheless, home health agency staff told him that while they would continue to provide nursing, the physical therapy was not reasonable and necessary and would be ending. Mrs. R questioned the agency about a maintenance therapy plan of care, and was told Medicare does not cover maintenance therapy, or at least not for someone with ALS. After Mrs. R showed the home health agency relevant components of the law, as provided by the Center, the agency claimed it simply did not provide maintenance care. The Center advocated for Mr. R by speaking with multiple representatives of the agency, including the Chief Clinical Officer and General Counsel, about Medicare coverage rules, maintenance care, and the Jimmo Settlement. The Center also coordinated a call with the home health agency and a physical therapist with expertise in maintenance therapy and necessary documentation. As a result of the Center’s advocacy, Mr. R is again receiving physical therapy at home.

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