By Mel Tanzman, Executive Director
Have you or a loved one ever received home skilled services or outpatient Therapy under Medicare only to have services terminated because you have, according to your provider, reached your maximum rehabilitation potential? Well if this has happened to you a recently settled law suit against Medicare may reopen the possibility of continued services.
The proposed settlement agreement was filed in federal District Court on October 16, 2012. When the judge approves the proposed agreement, a process that may take several months, the Medicare Benefit Policy Manual and other Medicare Manuals will be revised to correct all suggestions that Medicare coverage is dependent on a beneficiary “improving.” New policy provisions will state that skilled nursing and therapy services necessary to maintain a person’s condition can be covered by Medicare.
As a result of this tremendous victory by advocates consumers should discuss with their health care providers this revised Medicare standard and whether it is applicable to them. Health care providers should apply the maintenance standard and provide medically necessary nursing services or therapy services, or both, to patients who need them to maintain their function, or prevent or slow their decline. Under the maintenance standard articulated in the settlement, the important issue is whether the skilled services of a health care professional are needed, not whether the Medicare beneficiary will “improve.”
Many related issues regarding Medicare Home Care services remain including an outmoded requirement that a recipient of skilled home care services must be considered “Homebound” in order to be eligible for services. This often misinterpreted rule has limited the availability of home care services. One important thing to remember is that Medicare Home Care is only provided when a person requires skilled services of a nurse or therapist at home. If you mainly require personal care for tasks such as dressing bathing, or toileting, these services will not be provided under Medicare. Long Term Care services of this type are only covered under Medicaid.
If you or a loved one needs Medicare or Medicaid benefits, please contact our offices.