The New York Times (9/13, D5, Span, Subscription Publication) reports that beneficiaries are often told Medicare will no longer cover physical therapy or nursing home stays because they are “stable and chronic,” or have reached “maximum functional capacity,” or they have plateaued.
Seniors “with chronic and progressive diseases – dementia, Parkinson’s, heart failure” – are typically given this incorrect assessment, even though a 2013 settlement of a class-action suit mandated that Medicare “cover skilled care and therapy when they are ‘necessary to maintain the patient’s current condition or prevent or slow further deterioration.’”
In addition, last month, a Federal judge ordered CMS “to do a better job of informing health care” professionals “and Medicare adjudicators that the so-called improvement standard was no longer in effect.” The judge said that while CMS does not have to further update its manuals, it must do a better job of educating the medical community about these changes.
Related Links:
— “Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage,” Paula Span, New York Times, September 12, 2016.