Medicare coverage extended regardless of beneficiary’s condition “plateauing”

Settlement delays nursing home care, allowing seniors to age in place.


On January 24th, the Settlement in the Medicare Improvement Standard case was approved which guarantees that people with chronic conditions will continue to receive Medicare coverage regardless of whether their condition improves.  This is a major win for individuals with health problems and disabilities such as Alzheimer’s disease, Parkinson’s disease, Multiple Sclerosis and paralysis due to stroke and spinal cord injuries who in the past have been denied Medicare coverage because they had reached a plateau in their progress.  Now, beneficiaries will be able to continue to receive skilled nursing facility care, home health care or out-patient therapy (physical therapy, occupational therapy or speech therapy) for as long as they need it.  This is also a win for seniors who, without continued home health care or out-patient therapy would otherwise be forced into nursing home care and prevented from their goal of aging in place.    Now, seniors getting skilled services at home under a doctor’s order will be allowed to continue receiving this coverage indefinitely.

A recent NY Times blog points out that Federal officials say that the settlement is not a change in existing Medicare coverage rules but most beneficiaries as well as providers are not aware of this and it’s not well publicized.  Medicare officials now have until next January to notify health care providers but there’s no requirement to inform patients.

In order to help patients, the Center for Medicare Advocacy offers free “self-help” packets explaining how to challenge a denial of coverage this is based on lack of improvement.  Judith Stein, the lead attorney for the plaintiffs in the case and the executive director for the Center also encourages patients to bring a copy of the settlement to their next physical therapy appointment to show their provider if they’re worried about losing Medicare coverage.

Additionally, people who feel they were denied Medicare coverage for skilled nursing or therapy services in a skilled nursing facility, at home or as outpatients due to lack of progress after January 18,2011, when the lawsuit was first filed, can request a review of their case.

I strongly urge anyone with a chronic health issue or disability to visit the Center for Medicare Advocacy site and view the Frequently Asked Questions to understand your rights for continuing Medicare benefits.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.

lillian philbin February 17, 2013 at 03:50 PM
Terrific news for seniors and their caregivers.


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