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.”
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Reference: The New York Times (October 22, 2012) “Settlement Eases Rules for Some Medicare Patients”