Talk With Your Elder Lawyer about Recent Medicare Changes
November 4th, 2013
Recent changes to Medicare are giving elder lawyers and their clients some new options, meaning you may want to meet with your attorney to see if they apply to you.
A class-action lawsuit was recently brought, and the proposed settlement has some big implications for those with disabilities and chronic conditions.
For decades, standard Medicare practice was to not provide skilled nursing and therapy for those whose conditions were unlikely to improve. This has caused considerable problems for those with chronic or terminal conditions or with disabilities who would still have benefitted from these services. Now, home health care, outpatient therapy, and skilled nursing are much more likely to be covered for a chronic illness or disability.
The class-action suit was brought by a large group of people, with plaintiffs including organizations such as the National Multiple Sclerosis Society, the Parkinson’s Action Network, Paralyzed Veterans of America, and others. As a result of the outcome, it appears that more than 10,000 individuals who had claims denied earlier may be able to have those same claims reviewed again with different results.
According to the agreement, Medicare will begin to cover these services when they “maintain the patient’s current condition or prevent or slow further deterioration.” This is great news for those whose condition isn’t expected to improve but who still require assistance to improve their quality of life.
According to the New York Times, this change has potential to help those with:
- Multiple Sclerosis
- Spinal Cord Injuries
- Traumatic Brain Injury
Elder lawyers see this as a positive change for clients who were often denied care because they simply couldn’t afford it and Medicare wouldn’t cover their needs. However, there is still a potential for Medicare contractors to use more restrictive guidelines that could deny coverage for therapy or skilled nursing if the patient isn’t showing improvement.
The proposed changes are geared toward those in the traditional Medicare program, as well as to those with private Medicare Advantage. Most Medicare recipients are 65 and older, which is why a skilled elder lawyer keeps abreast of these kinds of changes that might affect clients.