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03-27-2014, 10:26 AM
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#1
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Gone but not forgotten
Join Date: Jul 2012
Location: Peru
Posts: 6,335
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Major change in Medicare
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.
Quote:
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.
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03-27-2014, 10:33 AM
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#2
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Jun 2002
Location: Texas: No Country for Old Men
Posts: 50,022
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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.
__________________
Numbers is hard
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03-27-2014, 10:50 AM
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#3
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Administrator
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,726
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Quote:
Originally Posted by REWahoo
Thanks for posting this - It is a significant change in Medicare policy.
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+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.
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03-27-2014, 10:59 AM
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#4
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Gone but not forgotten
Join Date: Jul 2012
Location: Peru
Posts: 6,335
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03-27-2014, 11:03 AM
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#5
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Thinks s/he gets paid by the post
Join Date: Jan 2005
Location: DFW
Posts: 2,016
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+2. Wonder why beneficiaries were not Informed. Anyway, good to know.
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Resist much. Obey Little. . . . Ed Abbey
Disclaimer: My Posts are for my amusement only.
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03-27-2014, 11:54 AM
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#6
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Thinks s/he gets paid by the post
Join Date: Oct 2008
Posts: 1,608
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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.
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