Medicare recipients with chronic conditions will now receive care under the program regardless whether or not their situations are likely to improve, according to an article from the Wall Street Journal.
A legal settlement between the federal government and consumer advocate groups have paved the way for these Medicare patients to receive care both at home and in skilled-nursing facilities, as well as outpatient facilities.
The Wall Street Journal writes:
The settlement, which covers those enrolled in both original fee-for-service Medicare and private Medicare Advantage plans, requires Medicare to end a long-standing practice of denying coverage for skilled-nursing services and physical, speech and occupational therapy to patients whose conditions are unlikely to improve.
To receive this coverage, patients must meet specific requirements. First, a doctor must prescribe care from a nurse or therapist. Patients in skilled-nursing facilities also must demonstrate a need for daily services from a nurse or therapy five times a week, says William Dombi, vice president for law at the National Association for Home Care and Hospice.
To secure coverage for home health care, Medicare requires a patient to be homebound, which typically means the individual needs help moving about from a device (like a wheelchair) or a person. A doctor must approve a “plan of care” every 60 days that includes the services of a nurse or a physical or speech therapist. In addition, the patient must contract with a home health agency certified by Medicare.
Written by Jason Oliva