Two federal courts in the past two months have ruled that Medicare’s coverage of skilled care does not require a beneficiary to show improvement. Instead, both courts said that Medicare can pay for skilled care if it is needed simply to preserve a patient’s current functioning or prevent further decline.
Home health agencies and nursing homes that contract with Medicare routinely terminate the Medicare coverage of a beneficiary who has stopped improving, adhering to what Medicare advocates have referred to as an “urban legend” that such beneficiaries are receiving “custodial care”, which Medicare does not cover. These beneficiaries could include those with chronic conditions and disabilities like multiple sclerosis, Alzheimers disease, ALS and broken hips.
In terminating the coverage, the Medicare contractors are not following the Medicare statute or its regulations, neither of which states that improvement is required for continued skilled care.
Contact a law firm concentrating in Elder Law for further information.