Under New Settlement, Home Care Under Medicare Made Easier

More patients would be able to access home health care through Medicare benefits to treat chronic conditions as a result of a class action lawsuit settlement with policy implications announced this week. 

In the proposed settlement, the Obama Administration has agreed to abandon a former policy that required Medicare recipients to show a likelihood of improvement, the New York Times reports. 

Under the new agreement, access will become more available. The New York Times reports


Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such 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.

Judith A. Stein, director of the nonprofit Center for Medicare Advocacy and a lawyer for the beneficiaries, said 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. It could also provide relief for families and caregivers who often find themselves stretched financially and personally by the need to provide care.


“As the population ages and people live longer with chronic and long-term conditions,” Ms. Stein said, “the government’s insistence on evidence of medical improvement threatened an ever-increasing number of older and disabled people.”

In many cases, she said, the denial of coverage led to a denial of care because most people cannot afford to pay for these services on their own….

Read the full article at NY Times.com

Written by Elizabeth Ecker

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