There has been a change in Medicare policy that affects those individuals who have chronic conditions such as multiple sclerosis, Parkinson’s, Alzheimer’s disease, ALS, diabetes, heart disease, and stroke. Until now, patients who had a chronic condition or disability had to show a likelihood of improvement in their condition in order to receive Medicare coverage for skilled care and therapy services. The change in policy enables patients who have “plateaued”, or stopped making progress, to continue receiving the services of a nurse or a therapist, and Medicare cannot deny coverage to patients for skilled nursing care, home health services or outpatient therapy because their conditions are not improving.
This ruling will have a big impact on patients who depend on or need some kind of skilled care to maintain their level of functioning or to prevent further deterioration. The old policy left many patients to pay for their own care, or even to discontinue care if they couldn’t show proof of improvement.
This change is expected to affect many, many Medicare beneficiaries and their families. Not only that, but this decision could also benefit the overburdened Medicare budget by delaying nursing home care. More seniors could be able to stay in their own homes longer.
The revisions to the Medicare manual came about because of a class action lawsuit filed in 2011 on behalf of four Medicare patients and five national organizations including the National Multiple Sclerosis Society and the Parkinson’s Action Network. The settlement of this lawsuit addresses care from skilled professionals including home health and nursing home care, therapy services from physical, occupational and speech therapists.
For seniors who are receiving services at home under a doctor’s order, this change means that Medicare’s home health coverage has no time limit.
It’s important to note that the existing eligibility criteria for Medicare has not changed, so there may be other reasons that one is denied or dropped from coverage.
Medicare officials were required to inform health care providers and bill processors of the new policy, but have not been required to notify beneficiaries, so many Medicare patients may not yet know of this change.
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