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.

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