A Quiet but Impactful Change for Medicare

Americans are living longer and our population demographics are shifting dramatically older.  As our population ages the number of Americans relying on Medicare for health care insurance will continue to increase.  Understanding what is covered by Medicare is important to our increasing number of Medicare beneficiaries.  As we analyze and debate our current health care system government insurance programs and particularly Medicare can expect to receive increased scrutiny.   Sometimes that scrutiny comes in the form of legal action like the lawsuit filed in 2011 against Kathleen Sebelius, the secretary of health and human services, by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of four Medicare patients and five national organizations, including the National Multiple Sclerosis Society, Parkinson’s Action Network and the Alzheimer’s Association.  The Plaintiffs filed the suit to challenge the long-standing “improvement standard” for care rendered to Medicare beneficiaries.  The case was settled with Medicare agreeing to revise it’s policies to eliminate any perceived “improvement standard” for eligibility and replace it with a “maintenance standard”.  While the case and the settlement received fairly significant coverage, the actual policy revisions, which happened in January, did not.  In January, Medicare officials updated their policy, to erase any notion that improvement is necessary to receive coverage for skilled care. That means Medicare now will pay for physical therapy, nursing care and other services for beneficiaries with chronic diseases like multiple sclerosis, Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration.  This settlement/policy revision does nothing to alter the 100-day limit for coverage of skilled nursing care, but it should make it much easier for individuals with chronic conditions to obtain coverage for the full period.

This article from the New Old Age Blog at the New York Times discusses the policy revisions: