ElderLaw News — The Estate Planning & Elder Law Firm, P.C. — MD, VA, DC
ElderLaw News

ElderLaw News is a weekly e-newsletter that brings you reports of legal developments and other trends of vital interest to seniors and their advocates. This newsletter is brought to you by The Estate Planning & Elder Law Firm, P.C., William S. Fralin, Esq., President., William S. Fralin, Esq., President.

Medicare to Cover More Home Health Services

Good news for Medicare recipients!

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 signed 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 are 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.)


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The Estate Planning & Elder Law Firm, P.C. is an elder law firm. We represent older persons, disabled persons, their families, and their advocates. The practice of elder law includes estate planning, estate and trust administration, powers of attorney, advance medical directives, titling of assets and designations of beneficiaries, guardianships, conservatorships, and public entitlements such as Medicaid, Medicare, Social Security, and SSI, disability planning, income tax planning and preparation, care management, and fiduciary services. For more information about The Estate Planning & Elder Law Firm, P.C., please visit our website at http://www.chroniccareadvocacy.com.

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