Settlement Eases Rules for Some Medicare Patients | Michigan ...

Rosalie J. Berkowitz, 82, was denied home-health coverage by Medicare because her condition caused my multiple sclerosis was not improving.

Tens of thousands of people with chronic conditions and disabilities may find it easier to qualify for Medicare coverage of potentially costly home health care, skilled nursing home stays and outpatient therapy under policy changes planned by the Obama administration.

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 in a proposed settlement of a nationwide class-action lawsuit. Under the agreement, Medicare will pay for 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. The proposed settlement could help people with chronic conditions like Alzheimer?s disease, multiple sclerosis, Parkinson?s disease, stroke, spinal cord injuries and traumatic brain injury. In addition, it could provide relief for families and caregivers who often find themselves stretched financially and personally by the need to provide care.

In many previous instances, the denial of coverage led to the denial of care because most people cannot afford to pay for these services on their own. Medicare officials could not say how much the settlement might cost the government, but the price of expanding such coverage could be substantial. Dr. Lynn Gerber, director of the Center for Study of Chronic Illness and Disability at George Mason University in Virginia called the settlement ?a landmark decision for Medicare recipients with chronic illness and especially those with disability.

Neither the Medicare law nor regulations require beneficiaries to show a likelihood of improvement. But some provisions of the Medicare manual and guidelines used by Medicare contractors establish more restrictive standards, which suggest coverage should be denied or terminated if a patient reaches a plateau or is not improving or stable. In most instances, the contractors? decisions denying coverage become the final decisions of the federal government.

Contact elder law attorney Christopher Berry to stay current on the latest Medicare rules and regulations.

Attorney Christopher J. Berry is a Metro Detroit estate planning and elder law lawyer who helps families, seniors, veterans and business owners with their important legal needs. Oakland County estate planning lawyer, Christopher Berry is a partner in the Bloomfield Hills law firm of Witzke Berry PLLC. Mr. Berry practices in the areas ofestate planning, business, probate, veterans benefits & Medicaid planning. Follow Christopher on Twitter@chrisberryesq

Source: http://michiganelderlawcenter.com/settlement-eases-rules-for-some-medicare-patients/

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