Vitally important change to Medicare Home care coverage

Medicare provides rehabilitation coverages in a home, skilled nursing facility or in an outpatient setting. For as long as I have been an elder law attorney Medicare coverage ended when a patient's improvement ceased (sometimes referred to as "plateau"). However, in January a Federal Judge approved the settlement of a law suit sponsored by the Center for Medicare Advocacy seeking to eliminate the plateau standard. As a result of the settlement Medicare will not cease when a patient can not improve any further. The new standard is called a "maintenance" standard. This means that if a doctor certifies that a patient needs rehabilitation in order to maintain their current level of functioning, the patient has a right to continued services ( which could result in rehabilitation for the rest of the patient's life). Under the terms of the lawsuit the Center for Medicare and Medicaid Services must revise their manuals and train providers about the new standard. This change in policy will take time, but that does not mean that the maintenance standard is not the current law. Therefore, if you are told a loved one no longer is eligible for rehabilitation because of the plateau, there is a simple appeal process, which, in light of the law suit settlement, should be successful.

Harold Grodberg is a member of the Union County Family Caregiver Coalition. The Caregiver Coalition is comprised of members from a variety of disciplines and provide patient education and family support services throughout Union County. You can learn more about the Union County Family Caregiver Coalition at www.cfcares.org.