Starting this year, the key criterion for [Medicare} coverage is a demonstrated need for skilled care – even if the patient isn't expected to improve. That means patients already enrolled in Medicare Part A (hospitalization) who need care to maintain their current condition but aren't likely to improve now qualify for Medicare's standard benefits.
Sometimes big legal changes happen. Nevertheless, sometime you still have to point out these changes to the powers that be. Sometimes you must do so over and over for the real changes to manifest.
As you may know, Medicare has recently undergone a big change affecting long-term care and the availability of skilled nursing or therapy. Namely, thousands are now eligible for Medicare benefits, but you might just have to point that out to care providers.
The slow transition to full adoption of the rules and new standards of care, as well as the continuing plight of those left in a lurch, is discussed in a recent Reuters article titled “New Medicare coverage of long-term care off to a rocky start.” As pointed out there, you or a loved one may be eligible for benefits, but may need to fight to receive the benefits.
Formerly, Medicare would only pay for skilled nursing or physical therapy sessions if there were signs of improvement. The trouble is that skilled nursing and therapy are not always about improvement but about maintenance, or even slowing a natural decline to keep a patient in a positive state.
The rules were challenged and the case of Jimmo v. Sebelius brought about relaxed rules, allowing such services for far broader classes of patients. Medicare communicates these kinds of changes directly to healthcare providers and not to beneficiaries. However, it seems many beneficiaries are having to figure it out for themselves and push institutions to adopt the changes. As a Medicare beneficiary, it may be important to know what the new rules mean and how to advocate for your care or the care of a loved one.
The original article offers some important resources like the Center for Medicare Advocacy, as well as the Medicare Rights Center. Each of these resources has some helpful guides and much more information on this and other relevant issues.
Reference: Reuters (April 29, 2014) “New Medicare coverage of long-term care off to a rocky start”