By Attorney Liz Durnell
In all of my time working with the elderly, one of the most discussed issues is “how long will Medicare pay for my nursing home?” The maximum amount of time that Medicare will pay for skilled nursing care is 100 days. Medicare pays 100% for the first 20 days. For days 21-100, they will pay all but a co-pay that is usually covered by supplemental insurance.
In the past, the question of how long Medicare paid depended on when the nursing homes decided that the patient was no longer improving or had “plateaued”. Once plateaued, Medicare stopped paying.
A recent settlement between the Center for Medicare Advocacy, Vermont Legal Aid and the Obama Administration has changed this standard.
Following is an excerpt from the ElderLaw Answers article, “Medicare to End ‘Improve or You’re Out’ Standard for Coverage of Skilled Services.”
“In a major change in Medicare policy, the Obama administration has provisionally agreed to end Medicare’s longstanding practice of requiring that beneficiaries with chronic conditions and disabilities show a likelihood of improvement in order to receive coverage of skilled care and therapy services. The policy shift will affect beneficiaries with conditions like multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, ALS (Lou Gehrig’s disease), diabetes, hypertension, arthritis, heart disease, and stroke.”
As part of the proposed settlement, which the federal judge must still formally approve, Medicare will revise the manual that their contractors follow to clarify that Medicare coverage of skilled nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement” but rather depends on whether or not the beneficiary needs skilled care, even if it would simply maintain the beneficiary’s current condition or slow further deterioration.
If you or a loved one are in a nursing home or assisted living facility or in the need of in home care, please contact the Elder Law Attorneys at Cooper, Adel & Associates to discuss your options.
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