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Subject:  OT: Medicare covers skilled home care Date:  2/21/2013  11:45 PM
Author:  WendyBG Number:  871880 of 902465

I'm posting this here because it may be welcome news to some board members.

Courts Reject 'Urban Legend' That Medicare Nursing Coverage Requires Improvement

In welcome news for seniors and the disabled with chronic conditions, two federal courts in the past two months have ruled that Medicare's coverage of skilled care does not require a beneficiary to show improvement. Instead, both courts said that Medicare can pay for skilled care if it is needed simply to preserve a patient's current functioning or prevent further decline.

Home health agencies and nursing homes that contract with Medicare routinely terminate the Medicare coverage of a beneficiary who has stopped improving, adhering to what Medicare advocates have referred to as an "urban legend" that such beneficiaries are receiving "custodial care," which Medicare does not cover. These beneficiaries could include those with chronic conditions and disabilities like multiple sclerosis, Alzheimers disease, ALS, and broken hips.

In terminating coverage, the Medicare contractors are not following the Medicare statute or its regulations, neither of which says improvement is required for continued skilled care....
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This is very important because skilled home care can maintain a chronically ill patient in a stable condition, while they could decline into an emergency with lack of care.

Wendy (cross-posted on METAR Board)
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