Big Potential Change to Medicare Rules


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Big Potential Change to Medicare Rules

Postby Robin » Tue Oct 23, 2012 12:52 pm

This proposed settlement of a lawsuit is a big deal to those in our community as it would affect skilled nursing home stays as well as home health and home therapy services for those with Medicare. Excerpts from the NYT article:

In a proposed settlement of a nationwide class-action lawsuit, the administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.

Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve.

Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement,” but is based on the beneficiary’s need for skilled care.



http://www.nytimes.com/2012/10/23/us/po ... ients.html

Accord to Ease Medicare Rules in Chronic Cases
By Robert Pear
Published: October 22, 2012
The New York Times
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