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Wednesday, February 20, 2013

Judge Approves Change to Medicare Improvement Rule, Health Services

Newsletter from February 15, 2013
Medicare Settlement Means No More “Improve or You’re Out”
Originally Posted on 02/6/2013 by Amy Goyer 
Judge Approves Change to Medicare Improvement Rule, Health Services

     A Federal Judge has approved the proposed Settlement Agreement in the Medicare Improvement Standard case, Jimmo vs. Sebelius, clearing the way for thousands of Medicare beneficiaries to receive needed health services to maintain their current level of functioning.
     The settlement, which represents a significant change in Medicare coverage rules, ends Medicare’s longstanding practice of requiring people to show a likelihood of improvement in order to receive coverage of skilled care and therapy services.
     The Agreement, which is retroactive to the date of the suite was filed, January 18, 2011, includes skilled services covered by Medicare Part A and Part B, such as speech, occupational and physical therapy, nursing and home health services, even when the goal is maintaining the patient’s current condition rather than requiring that the patient improving.
     The Medicare law has never supported the “improvement standard.” Nevertheless, for decades beneficiaries have been denied needed services because they are not improving or have “plateaued”, sometimes with devastating results. The Center for Medicare Advocacy says providing maintenance services will save money in the long run, preventing decline, hospitalizations and need for more expensive services.

     The official approval of the settlement means the Center for Medicare and Medicaid Services (CMS) must develop and implement an education campaign to ensure that Medicare providers are not denying coverage for vital maintenance services to those with any chronic illness who meet other qualifying Medicare requirements.
    The “maintenance standard” is effective immediately. Even though we have not seen the official documentation that Chiropractic Maintenance Care is included in this settlement, we are presently requesting a specific answer from CMS. If you or someone you are caring for has a chronic illness or needs skilled services to prevent further deterioration, contact your health provider.

Originally Posted on 02/6/2013 by Amy Goyer, see original link below:

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