Major change in Medicare

[imoldernu]

This won't resonate for younger people or those who don't have parents who might be involved in long term care, but it could be extremely important for those who ARE or COULD BE affected.

Ever since Cindy Hasz opened her geriatric care management business in San Diego 13 years ago, she has been fighting a losing battle for clients unable to get Medicare coverage for physical therapy because they “plateaued” and were not getting better.

“It has been standard operating procedure that patients will be discontinued from therapy services because they are not improving,” she said.

Glenda Jimmo at home in Lincoln, Vt., in 2012. She was the lead plaintiff in a lawsuit over whether Medicare should pay for treatment for people whose underlying conditions were not likely to improve.
No more. In January, Medicare officials updated the agency’s policy manual — the rule book for everything Medicare does — to erase any notion that improvement is necessary to receive coverage for skilled care. That means Medicare now will pay for physical therapy, nursing care and other services for beneficiaries with chronic diseases like multiple sclerosis, Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration.

But don’t look for an announcement about the changes in the mail, or even a prominent notice on the Medicare website. Medicare officials were required to inform health care providers, bill processors, auditors, Medicare Advantage plans, the 800-MEDICARE information line and appeals judges — but not beneficiaries.

 

[REWahoo]

Thanks for posting this - It is a significant change in Medicare policy.

My FIL spent several months in a nursing home after having a major stroke and had his physical therapy stopped once he “plateaued”. He started going downhill at that point and died less than three months later. I've always wondered if his deteriorating condition was the cause of his failure to show improvement or if ceasing physical therapy contributed to his decline.

 

[MichaelB]

Thanks for posting this - It is a significant change in Medicare policy.

+1

This may address one concern many forum members have expressed. If Medicare reimburses expenses incurred at home for assistance with ADLs, it might enable people to avoid a nursing home and remain at home longer. This is something to look into.

 

[imoldernu]

oops....Meant to post the link... http://newoldage.blogs.nytimes.com/2014/03/25/a-quiet-sea-change-in-medicare/?_php=true&_type=blogs&_r=0

 

[Eagle43]

+2. Wonder why beneficiaries were not Informed. Anyway, good to know.

Sent from my AT100 using Early Retirement Forum mobile app

 

[powerplay]

This looks like a good change with the potential to benefit many. Often something like a stroke requires ongoing physical therapy and progress can be slow. Hope the word gets out so this can benefit those who need the services.