Yeah, yeah, I know you feel like you’ve had more than enough from me about Medicare over the past ten days.
But this is big-deal, good news you need to know.
On Tuesday, the Obama administration announced a proposed settlement agreement that would make it easier for people with disabilities and chronic conditions to qualify for home care.
Until now, Medicare beneficiaries have been required to show they were likely to improve (the “improvement standard”) for Medicare to cover skilled nursing care and therapy services at home.
Weirdly, this has never been a medicare regulation. Reporter Robert Pear in The New York Times explained:
”Neither the Medicare law nor regulations require beneficiaries to show a likelihood of improvement. But some provisions of the Medicare manual and guidelines used by Medicare contractors establish more restrictive standards, which suggest coverage should be denied or terminated if a patient reaches a plateau or is not improving or is stable.
“In most cases, the contractors’ decisions denying coverage become the final decisions of the federal government.
Now, however, as an editorial in The New York Times noted:
”Medicare will pay for the services if they are needed to maintain the patient’s current condition or to prevent or slow further deterioration — regardless of whether the patient is expected to improve medically or in ability to function.”
This agreement came about due to a class action lawsuit brought by the Center for Medicare Advocacy (CMA) and Vermont Legal Aid against the U.S. Department of Health and Human Services (HHS).
Here is a good video explanation from Judith Stein, the founder of the Center for Medicare Advocacy, about why the lawsuit is important:
The proposed settlement, which you can read here [pdf], will affect both traditional Medicare and Advantage plans and will bring relief to tens of thousands of beneficiaries with such conditions as multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS (Lou Gehrig’s disease), cerebral palsy, diabetes, hypertension, arthritis, heart disease and stroke.
It will also be a help for families and caregivers – including some Time Goes By readers I know – who are often stretched to the financial and emotional limit due to full-time caregiving.
Experts are saying this will add a huge burden of new costs to Medicare. But it will also save a lot of money in nursing home care so there is no way to know yet how all that will balance out.
At The Elder Storytelliing Place today, Judith Cooper Eton: Properly or Improperly in Love