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Rehabilitation, New Injury & Recovery Programs

Information about finding the right rehabilitation facility for you, learn about the SCI Model System Centers, and rehab resources.

1. Choosing a Rehabilitation Setting

1.1. Arbitrairy Therapy Caps Removed

Congress Lifts Limits on Therapy

Nearly 6 million Medicare beneficiaries used outpatient therapy services in 2015, allowing many of them to maintain their independence.

En español |  Millions of Medicare beneficiaries will be able to afford the physical, speech or occupational therapy they need because the payment caps on those services were permanently repealed as part of the budget deal the president signed into law Friday morning.

Since January, older adults have lived with uncertainty about whether Medicare would cover all the therapy they need to recover from falls or strokes, or to manage chronic illnesses. It’s common for someone who has had a stroke, hip fracture or other injury to need intensive therapy to learn how to speak and walk again or feed themselves. Patients who suffer from conditions such as arthritis, Parkinson’s disease or multiple sclerosis also often need therapy to handle the tasks of everyday living.

For two decades, payments for these treatments have been capped, with Congress periodically passing bills that provided automatic exceptions for the reimbursement limits when the treatments were deemed medically necessary. Congress did not act in 2017 and, as of January, Medicare beneficiaries who reached the caps — $2,010 for physical and speech language therapy combined, and $2,010 for occupational therapy — worried they might not be able to afford to continue to get the treatments they need.

“Millions of vulnerable patients who need occupational, physical and speech-language therapy will now be protected from an arbitrary limit on how much Medicare will pay for needed therapy,” said Nancy LeaMond, AARP’s executive vice president and chief advocacy and engagement officer. LeaMond applauded the inclusion of the therapy cap repeal, which AARP has long supported, in the budget bill.

An analysis commissioned by the American Occupational Therapy Association found that nearly 6 million Medicare beneficiaries used outpatient therapy services in 2015. Rehabilitative care often allows older Americans to maintain their independence and remain at home rather than go to a nursing home or other long-term care facility.


1.2. What to expect in inpatient rehabilitation (streaming video presentations)

From SHARP HealthCare in San Diego, this Sharpe video presentation explains the role of acute rehabilitation and the resources available through a quality rehabilitation center.

Shepherd Center (Atlanta, GA) TV rehabilitation video overview

 

1.3. The importance of rehabilitation

In his autobiography, A World to Care For (Random House, 1977), the father of rehabilitation, Dr. Howard Rusk wrote: "...once a person overcomes a disability through his own courage, determination and hard work, he has a depth of spirit you and I know little about.....[this] is a branch of medicine in which the patient has more power than the doctor in setting the limits and possibilities......"

Following the acute trauma care that medically stabilizes the person who has sustained a spinal cord injury/disorder (SCI/D), the individual is transferred to acute rehabilitation. A rehabilitation program may be in the same or a different facility or a free-standing facility.

The goal of rehabilitation is to help persons learn how to care for a body that now works differently, maintain a high level of health that avoids the secondary complications of SCI and reintegrate oneself into the community.

In acute (intense) rehabilitation, the SCI/D person (and his family/significant other) becomes an important member of a team of SCI professionals that include physical medicine, nursing, occupational and physical therapy, social work, psychology and recreation. A SCI team of experts has the skill to provide a comprehensive, multidisciplinary, lifetime approach that is so essential to the care of the person who is newly injured.

United Spinal Association encourages all persons to seek their acute rehabilitation in a facility that provides a dedicated SCI program that can address the unique, life-long needs of these persons. [Insurance, location and individual circumstances will affect a final placement decision.]Appropriate rehabilitation begins the journey to an improved quality of life for each person who has experienced this life-changing event.

There are two programs that designate/accredit a facility as a SCI program of rehabilitation. The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), part of the U.S. Department of Health and Human Services' Administration for Community Living, designates the Spinal Cord Injury Model Systems centers. The Model Systems provide comprehensive care from the time of admission, following an acute injury, through rehabilitation to discharge and reintegration into the community.

The Commission on Accreditation of Rehabilitation Facilities (CARF) accredits facilities that provide rehabilitation services and programs, both inpatient and outpatient, that are specific for SCI/D. Please access the lists of these specialized facilities; Spinal Cord Injury Systems of Care.

1.4. Choosing a High-Quality Rehabilitation Program

Choosing a High-Quality Rehabilitation Program
An NRH Field Guide for People with Disabilities

This guidebook was developed to help consumers choose a high-quality rehabilitation program. It covers the different types of rehabilitation programs available and offers assistance with understanding your insurance coverage. It also includes a glossary of terms as well as checklists and additional resources.

1.5. Finding the right rehab facility for you

For information to help you learn how to select the right rehabilitation facility, visit:

  • Spinal cord injury-You DO have choices from the Research and Training Center on Independent Living, University of Kansas
  • State resource pages where Spinal Cord Injury Model Systems, CARF accredited rehabilitation hospitals, and Affiliate Service Providers are listed
  • Please refer to teh attachment onthis page, "Educating Nursing Staff about SCI" if you hapen to be working with a non-SCI rehab or nursing home setting.

*Please note that the United Spinal Association does not specifically endorse any healthcare facility

 

2. SCI Model Care Systems

2.1. What are SCI Model Care Systems?

Learn about the SCI Model Care Systems

Spinal Cord Injury (SCI) Model System, sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) , Office of Special Education and Rehabilitative Services, U.S. Department of Education, supports innovative projects and research in the delivery, demonstration, and evaluation of medical, rehabilitation, vocational and other services to meet the needs of individuals with SCI. NIDILRR awards SCI Model Systems Center grants to institutions that are national leaders in medical research and patient care and provide the highest level of comprehensive specialty services, from the point of injury through rehabilitation and re-entry into full community life. Grants are awarded in five-year cycles (the current cycle is 2016-2021). Each SCI Model Systems Center contributes to the SCI Model Systems Data Center, participates in independent and collaborative research, and provides information and resources to individuals with SCI, their family and care givers, health care professionals and the general public. - See more at: http://www.msktc.org/sci/model-system-centers#sthash.mSzNR0up.dpuf

2.2. SCI Model Systems list

Spinal Cord Injury (SCI) Model Systems (2016-2021) listing of the current 14 Model Systems of Spinal Cord Care.

Spinal Cord Injury (SCI) Model System, sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Administration for Community Living, U.S. Department of Health and Human Services, supports innovative projects and research in the delivery, demonstration, and evaluation of medical, rehabilitation, vocational and other services to meet the needs of individuals with SCI.

NIDILRR awards SCI Model Systems Center grants to institutions that are national leaders in medical research and patient care and provide the highest level of comprehensive specialty services, from the point of injury through rehabilitation and re-entry into full community life. Grants are awarded in five-year cycles (the current cycle is 2016-2021).

Each SCI Model Systems Center contributes to the SCI Model Systems Data Center, participates in independent and collaborative research, and provides information and resources to individuals with SCI, their family and care givers, health care professionals and the general public.

3. Commission on Accreditation of Rehabilitation Facilities (CARF)

3.1. What does CARF mean?

Learn more about spinal cord injury care in a CARF-accredited facility CARF Accreditation  

"Consumers like you have choices in directing your services. Carefully researching and selecting your options are essential steps to finding the services you need and achieving the results you desire.

Accreditation demonstrates a provider's commitment to continuously improve service quality and to focus on the satisfaction of the persons served.

CARF International is an independent, accrediting body of health and human services. Examples of the types of services are rehabilitation for a disability, treatment for addiction and substance abuse, home and community services, and retirement living. CARF-accredited service providers have applied CARF's comprehensive set of standards for quality to their business and service delivery practices. This means that they have demonstrated conformance to proven standards for business practices and are committed to continuous quality improvement. Each provider's commitment to excellence is periodically evaluated on site and reconfirmed annually." (CARF) 

3.2. Finding a SCI CARF-accredited facility

You can search for an alphabetical listing of accredited CARF facilities

To search for a spinal cord system of care, select "Spinal Cord System of Care" in the "Program Focus" field. Do not select a program in the "Program" field that starts with the words Spinal Cord.

4. Rehabilitation Resources

4.1. Medicare Covers Maintenance Therapy / Skilled Nursing

For Immediate Release
August 28, 2017

As ordered by the federal judge in Jimmo v. Sebelius, the Centers for Medicare and Medicaid Services (CMS) published a new webpage containing important information about the Jimmo Settlement on its CMS.gov website. The Jimmo webpage is the final step in a court-ordered Corrective Action Plan, designed to reinforce the fact that Medicare does cover skilled nursing and skilled therapy services needed to maintain a patient's function or to prevent or slow decline. Improvement or progress is not necessary as long as skilled care is required. The Jimmo standards apply to home health care, nursing home care, outpatient therapies, and, to a certain extent, for care in Inpatient Rehabilitation Facilities/Hospitals.

The Jimmo webpage and other elements of the Correction Action Plan should help ensure that the Jimmo Settlement is implemented correctly and that it opens doors to Medicare coverage and necessary care for beneficiaries who require maintenance care, including people with long-term, progressive, or debilitating conditions. As required by the Court, CMS also provided additional training for Medicare decision-makers.

Judith A. Stein, Executive Director of the Center for Medicare Advocacy, which is lead counsel for the nationwide class of Medicare beneficiaries said, "People living with MS, Parkinson's Alzheimer's, paralysis and other long-term conditions have waited long enough for this relief. We hope that the new CMS education and information, which can be found at CMS.gov and printed out with the CMS logo, will help convince providers that Medicare really is available for people who need this critical maintenance care."

"After years of fighting over this standard in court, we are hopeful that Medicare has finally acknowledged that beneficiaries with long-standing and chronic problems are entitled to maintenance skilled care to prevent or slow decline in their overall condition," said Michael Benvenuto, of Vermont Legal Aid, co-counsel for the Jimmo plaintiffs.

The new webpage contains an "Important Message About the Jimmo Settlement," in which court-approved language emphasizes that the Settlement "may reflect a change in practice" for providers and Medicare decision-makers who erroneously believed that the Medicare program covers nursing and therapy services only when a beneficiary is expected to improve.  Indeed, the new education and Jimmo webpage are important because many health care providers still operate under this misconception, leading beneficiaries to be wrongly denied needed services such as physical and occupational therapy.

This was the case, for example, for Mrs. B, who was denied necessary on-going physical therapy, needed to maintain her condition after spinal surgery. While she had begun to walk again independently after nursing home care, and out-patient PT, when the PT ended because it was "maintenance only," Mrs. B declined and was no longer able to ambulate independently.

One of the "Frequently Asked Questions" posted on the Jimmo CMS.gov page clarifies that this should not happen: "The Medicare program does not require a patient to decline before covering medically necessary skilled nursing or skilled therapy."

The Jimmo webpage contains fifteen such "Frequently Asked Questions," which dispel other mistaken beliefs.  One answer, confirms: "Skilled services would be covered where such skilled services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care to the services to be safely and effectively provided."

Judge Christina Reiss of the U.S. District Court in Vermont ordered the corrective action plan in February 2017 after finding that CMS was in breach of the original Jimmo settlement agreement, which was reached in 2013. In addition to the webpage, the Corrective Action Plan required CMS to offer additional training about coverage for skilled maintenance care for Medicare's contractors and adjudicators who decide whether coverage will be granted.

Under the original Jimmo Settlement, CMS revised several chapters of its policy manuals (including those for Skilled Nursing Facility, Home Health, Out Therapy and Inpatient Rehabilitation Facility.) CMS also held an educational campaign to clarify that improvement is not required for coverage of skilled care. Lawyers for the Jimmo plaintiff class requested further action from the court when it became clear that too many people were still being wrongfully denied Medicare coverage – in part because many medical providers had not been adequately educated, and in part because many providers were still skeptical that Medicare would alter its coverage practices. The new webpage offers CMS's official imprimatur on the correct legal standard that improvement is not required when there is a need for skilled care.

4.2. Other rehabilitation Resources

For additional SCI rehabilitation information, visit:

Courage Center ( Minnesota) Inpatient Transitional Rehabilitation Program, CARF-accredited

Winning Wheels Rehabilitation Center (Prophetstown, IL) Continuum of Care rehabilitation program, CARF-accredited

Case Management Resource Guide on line with 150,000 diverse listings

5. Post-Acute Recovery SCI Programs

5.1. Beyond Therapy-Atlanta, GA

The Beyond Therapy program at Shepherd Center in Atlanta. GA is a rigorous, activity-based therapy program designed to help people with a variety of neurological disorders, including spinal cord injury, improve their lifelong health, minimize secondary complications and get the most out of any new neural links to their muscles.

5.2. Center for Neuro Recovery

Center for Neurorecovery

The comprehensive activity based strength training (C.A.S.T.) program at the Center for Neuro Recovery®
was founded over 10 years ago with a simple philosophy: "Help our clients live independently by achieving
strength and function to perform their Activity of Daily Living (ADL) skills."
Center for Neuro Recovery comprehensive activity based strength program (C.A.S.T.) has helped numerous
post rehabilitation clients regain strength, independence, mobility, and confidence after a stroke, spinal
cord injury, or other neurological disorder.

Researchers and physicians worldwide now recognize the benefits of strength and conditioning for disabled
individuals. They encourage patients with stroke, spinal cord injury, or acquired neurological conditions
like Multiple Sclerosis (MS), Arteriovenous Malformation (AVM), Neuromyelitis Optica (NMO), Guillain-Barré
(GBS), or even Amyotrophic Lateral Sclerosis (ALS) to exercise rather than thehomeworkportal.com/ sit at
home, physically debilitate, and wait for whatever is to come.

401 Northlake Blvd. Suite 4
North Palm Beach, FL 33408
Phone 1-888-875-7659

 

5.3. C.O.R.E.-Northridge, CA

C.O.R.E. Centers – SCI Networking Group
Center of Restorative Exercise (C.O.R.E.)
9667 Reseda Blvd. Northridge, CA 91324
(818) 718-2673

5.4. Journey Forward-Canton, MA

Journey Forward is a not-for-profit recovery-based exercise therapy program for individuals with spinal cord injury or disease in Massachusetts.

5.5. Neurorecovery Network-multiple locations

Neurorecovery Network

Locomotor treadmill training You Tube video

 

Participating sites as of August 2013:

Craig Hospital, Englewood, CO

Frazier Rehab Institute, Louisville, KY

Magee Rehabilitation Hospital, Philadelphia, PA

The Institute for Rehabilitation & Research, Houston, TX

Shepherd Center, Atlanta, GA

Kessler Institute For Rehabilitation, West Orange, NJ

Ohio State University Medical Center, Columbus, OH

5.6. Next Step Fitness-Lawndale, CA

Next Step Fitness of Lawndale, CA is a nonprofit that provides people living with paralysis the opportunity for health and recovery through affordable and progressive community fitness and wellness facilities.

4447 Redondo Beach Blvd. Lawndale, CA 90260 (310) 546-5666

Christel Mitrovich (Director) ext. 11 christelm@nextstepfitness.org

5.7. PEAK Center at Craig Hospital-Englewood, CO

 PEAK Center

The PEAK Center at Craig Hospital is an adaptive health and wellness center serving individuals with neurologic disabilities in order to optimize their recovery and to create a lifelong plan for their health and wellness. 

5.8. Precision Rehabilitation-Long Beach, CA

Precision Rehabilitationis a physical therapy clinic specializing in neurological and orthopedic rehabilitation also providing speech pathology and acupuncture treatments.


3294 East Spring Street Long Beach, CA 90806 (562) 988-3570 d Wednesday of every month

Christy Malonzo

5.9. Project Walk- Multiple Locations

Project Walk® exists to provide an improved quality of life for people with spinal cord injuries through intense exercise-based recovery programs, education, support and encouragement. Provider Centers in several US states as well as internationally.....

5.10. Step It Up Recovery Center-Orlando, FL

Step It Up Recovery Center exists to provide those living with a spinal cord injury the opportunity to achieve their greatest recovery potential and an overall increased quality of life. We will achieve this with an innovative, specialized exercise-based recovery program, dedicated staff, in an environment filled with support, hope and motivation

5.11. The Recovery Project-Two Locations in MI

The Recovery Project Livonia, MI

We, along with the rest of the world, hope for a cure for paralysis in our lifetime. Regardless of whether the cure comes in 5, 10 or 50 years, we believe that individuals with spinal cord and other neurological injuries should pursue increased physical functionality and fitness. While researchers seek the remedy, our mission is to improve the lives and functionality of individuals with these injuries by providing an environment in which to rehabilitate, recover and stay fit.

The Parkhill Foundation Bloomfield Hills, MI

The Parkhill Foundation may be able to provide financial assistance for therapy participants without health insurance coverage nor other means to access therapy programs of The Recovery Project.  

5.12. Walk The Line-to SCI Resovery-Southfield, MI

Walk The Line-to SCI Resovery Center in Southfield, MI

"Walk The Line" combines the expertise of physician directed training programs with experienced, knowledgeable certified trainers to help each client reach their goals for RECOVERY.