Hook Law Center: Medicare to Cover More Home Health Services

Good news for Medicare recipients! Just in time for the New Year 2013! In the past, Medicare recipients were unable to receive home health services such as nursing care and therapies if they had a chronic condition. As a result of a court case that originated in Vermont, that is about to change. Vermont Chief Judge Christina Reiss will sign off on the settlement after a hearing on January 24, 2013. The settlement will apply nationally, and it will mean a big change from the current practice. At present, the Medicare recipients had to have had a reasonable chance of recovering from the condition before they could receive rehabilitative services in the home. Of course, sometimes it is difficult to make that prediction, so this ruling represents a giant step forward for patients. Now, they will be able to receive skilled nursing services as well as speech therapy and occupational therapy in the home, despite the fact that the patient may not fully recover. Those enrolled in both fee-for-service Medicare and private Medicare Advantage plans will also have this option.

Thanks for this change is due to action by the nonprofit organization called the Center for Medicare Advocacy. Under the direction of founder, Judith Stein, the center brought a class action suit which resulted in the new ruling. Tens of thousands of people are likely to be affected by the change. There are some qualifications–a doctor must give a prescription for the services to be renewed every 60 days and, for those in skilled nursing facilities, the services must to be such an extent that they are required 5x per week. Additionally, the patient must be classified by Medicare as “homebound,”  meaning they need assistance from a device (like a wheelchair or walker or a person) to ambulate. Finally, the services must be provided by an agency certified by Medicare.

Yet, this represents a tremendous victory for patients’ rights. If any difficulty is encountered in attempting to secure services, an appeal can be filed. A booklet called ‘Self-Help Packet for Home Health Denials’ is available at www.medicareadvocacy.org.  The site recommends that a doctor’s letter explaining the reason for services can also be of help. The word is just getting out, so don’t be surprised if everyone is not aware of the new change. Additionally, those denied services on or after January 18, 2011 will be granted a ‘special appeal.’ You and/or your loved ones will soon be receiving the care they have long desired!

(Information above taken from Anne Tergesen, “Medicare to Cover More Home Care,” Wall Street Journal (online), Dec. 17, 2012.)

Hook Law Center has been providing the highest quality of legal advice to the communities of Hampton Roads for more than 80 years. Our practice is dedicated to seniors, and disabled persons, their families and advocates. Our professional staff can respond to our client’s care needs on a 24 hour basis, and our Attorneys are available to provide expertise on every issue facing senior citizens from long-term and life care planning to estate and trust issues as well as financial, investment, public benefit, and insurance assistance. Visit their website for more information.


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