Wall Street Journal: Home Health Medicare Patients Find Hope In Appeals

Despite popular misconceptions, Medicare does provide some home care coverage, writes a Wall Street Journal article published this week. While patients with chronic conditions are often denied, there may be hope in the appeals process, WSJ says.

“In order to secure coverage for home health care, Medicare first requires a patient to be homebound. That doesn’t equate to being bed-bound, says Judith Stein, founder of the nonprofit Center for Medicare Advocacy. Rather, such individuals typically need help moving about from a device (like a wheelchair) or a person.

A doctor also must approve a “plan of care” that includes the services of a nurse or physical or speech therapist. (In addition, the plan can include the services of an occupational therapist and a home health aide to assist with so-called “activities of daily living,” such as bathing, eating and dressing.) The doctor must renew the “plan of care” once every 60 days, says Kim Glaun, senior education and policy counsel at the nonprofit Medicare Rights Center.

The patient must contract with a home health agency that is certified by Medicare. A hospitalization isn’t a prerequisite for coverage, Ms. Stein says.

A nurse or therapist can come to a patient’s home as often as daily or as infrequently as once every 60 days. But when nursing care occurs daily, Medicare will cover it only if there is “a predictable end to the need” for daily care, according to the Center for Medicare Advocacy….

Read the original article.

Written by Elizabeth Ecker