As I have previously written, a very contentious issue with Medicare has been Medicare cutting off coverage for home health care coverage when a patient is not improving. Medicare then classifies the patient as only needing custodial care as opposed to the skilled care which Medicare will provide coverage for up to the limits of the program. The Feds have been losing on this issue in Federal Court and are now responding. The Centers for Medicare & Medicaid Services (CMS) issued new regulations on November 17th regarding coverage for home health services. The new regulations clarify Medicare coverage for home health services, including physical therapy, occupational therapy and speech-language pathology services.The regulations are effective January 1, 2011; however, since they clarify rather than change coverage rules, they are also applicable to services prior to that time. To determine whether a service is skilled, and therefore coverable, the new regulations direct decision-makers to review accepted standards of clinical practice and to consider whether a professional is needed for the service to be safe and effective for the particular beneficiary.
These considerations, rather than the ability to improve, are the key factors to be considered in making coverage determinations. The rules state that they do not alter coverage, but rather provide additional detail for care planning, assessment, and reassessment. They should help advocates in their efforts to ensure that necessary services are covered, particularly for people with chronic conditions.
Read all about this and more at the website of the Center for Medicare Advocacy at www.medicareadvocacy.org
William Wombacher , a Central Illinois Certified Elder Law Attorney (CELA). I’ll help you!