Tens of thousands of people with chronic conditions
and disabilities may find it easier to qualify for Medicare coverage of
potentially costly home health care, skilled nursing home stays and outpatient
therapy under policy changes planned by the Obama administration.
Medicare may be opening the doors
to many who previously had been turned away and left without coverage for home
health care, nursing home stays and outpatient therapies on the basis of a less
than positive “improvement” prognosis. This change of course may actually be
the result of a nationwide class-action suit and an agreement from the
administration.
For a perspective on the
proposed settlement, turn to a recent article in The New York Times titled “Settlement Eases Rules for Some Medicare
Patients.”
The Medicare board has had a
longstanding practice to require a likelihood of medical or functional
improvement before a beneficiary could receive coverage for skilled nursing or
therapy services, whether institutional or home-based. That left many care
recipients in a lurch. If this settlement goes through and becomes practice,
then the requirement is no longer “improvement” but “maintenance.” Accordingly,
Medicare will provide services if they are needed to “maintain the patient’s
current condition or prevent or slow further deterioration.”
For more information and articles on
estate planning and elder law topics, please visit our website and sign up for our free monthly
e-newsletter.
You can also friend our law practice's Facebook page (R Christine Brown).
Reference: The New York
Times (October 22, 2012) “Settlement Eases Rules for Some Medicare Patients”