Eliminating the Need for Improvement... Beneficial Changes for Some Medicare Patients

In our spring 2012 newsletter, we stated that nursing homes may mistakenly require a resident to be improving or showing progress in order to continue to be covered by Medicare. One may see an incorrect denial of further Medicare coverage if a resident plateaus, or if the nursing facility says the resident can no longer be rehabilitated.

Now, as recently reported in the New York Times, the Obama administration pursuant to a proposed settlement of a nationwide class-action suit, has agreed to scrap a practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.

This agreement states that Medicare will now pay for such services if they are needed to "maintain the patient's current condition or prevent or slow further deterioration," regardless of whether the patient's condition is expected to improve.

Read the full article...

The Impact of Recent Elder Law Court Rulings

Earlier this year the Supreme Court upheld the Affordable Care Act, which by-and-large ensured the preservation and continued roll-out of improvements and protections for older adults.  

These improvements include the extension of Medicaid's spousal impoverishment protections to those seeking long-term care in the community, financial incentives for states to keep long-term care recipients out of institutions, the gradual closing of Medicare Part D's infamous doughnut hole, expanded access to preventive services for Medicare beneficiaries, and the Elder Justice Act.  

The Court did, however, scale back the Medicaid portion of the law, which could mean that fewer near-elderly will have access to health insurance than was originally envisioned. The law expanded Medicaid eligibility starting in 2014 to people with income up to 133 percent of the poverty line. But in its ruling, the Supreme Court gave states the freedom to opt out of this expansion without putting their current Medicaid funding at risk.

Naturally, these decisions will impact different people in different ways depending upon a number circumstances specific to each family's situation. To determine how your family might be affected, the safest course of action is to consult with your elder law attorney.