Many other patients, however, may not have even received certain kinds of treatment because their doctors figured that prescribing it would be pointless. “Once it becomes clear what Medicare will and will not pay for, you end up changing your practice pattern based on what it covers,” said Peter Thomas, a lawyer in private practice who is the outside counsel for the American Academy of Physical Medicine and Rehabilitation.

The settlement agreement takes pains not to describe itself as an expansion of Medicare coverage. But it does promise that the Centers for Medicare and Medicaid Services will revise the manuals their contractors use to make clear that coverage “does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy but rather on the beneficiary’s need for skilled care.”

Moreover, the settlement specifies that skilled care can qualify for Medicare coverage even if it merely maintains someone’s current condition or prevents or slows further deterioration. Certain patients who have had claims rejected will be able to resubmit them.

Representatives of several patient advocacy groups expressed hope this week that Medicare would soon pay for many forms of therapy that it did not always cover before.

For people with cerebral palsy, physical therapy to maintain muscle mass is one possibility. For multiple sclerosis patients, there may be more approval for treatments for spasticity and gait training to prevent falls.

The biggest question mark may be for the large numbers of people who suffer from dementia. According to Robert Egge, vice president for public policy at the Alzheimer’s Association, there are many benefits that come from delaying the long-term progression of dementia. Leslie Fried, director of policy and programs at the National Council on Aging, said there had been a particular Medicare claims bias over the years in applying the improvement standard to people with dementia and other forms of cognitive impairment.