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.
The result of a nationwide class-action suit and an agreement from the administration may change the course of Medicare qualifications, which is hopeful news for those who previously had been left without coverage. As it stands, beneficiaries must show a probability of improvement before Medicare will approve therapy and skilled nursing care. Ditching this age-old practice could mean huge relief to those with chronic or long-term conditions.
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.”
Not only would this be beneficial for those who have chronic conditions such as Alzheimer’s and Parkinson’s disease, but also for the families who are financially overextended from providing care to their loved ones. If successful, this settlement would have a huge impact on an already financial strapped program. It would likely require sweeping changes to the way we fund healthcare in this country. In my estimation, it's long overdue.
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Reference: The New York Times (October 22, 2012) “Settlement Eases Rules for Some Medicare Patients”