Medicare Coverage Skilled Nursing Qualifications May Be Eased

Medicare may be opening thedoors to many who previously had been turned away and left without coverage forhome health care, nursing home stays and outpatient therapies on the basis of aless than positive “improvement” prognosis. This change of course may actuallybe the result of a nationwide class-action suit and an agreement from theadministration.

For a perspective on theproposed settlement, turn to a recent article in The New York Times titled “Settlement Eases Rules for Some MedicarePatients.”

The Medicare board has had alongstanding practice to require a likelihood of medical or functionalimprovement before a beneficiary could receive coverage for skilled nursing ortherapy services, whether institutional or home-based. That left many care recipientsin a lurch. If this settlement goes through and becomes practice, then therequirement is no longer “improvement” but “maintenance.” Accordingly, Medicarewill provide services if they are needed to “maintain the patient’s currentcondition or prevent or slow further deterioration.” 

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