Medicare Settlement Could Change Standard for Therapy from Improvement to Maintenance
A recent pivotal Medicare settlement bodes well for rehabilitation providers and patients who must manage or maintain their current medical condition. The proposed settlement of the nationwide class action lawsuit Glenda Jimmo, et. al. vs. Kathleen Sebelius states that Medicare must cover the skilled care necessary to maintain a patient’s condition or prevent or slow further deterioration – even if there is no prognosis of recovery in the long term. According to the settlement, Medicare could no longer arbitrarily limit skilled nursing or therapy reimbursement for patients who need to maintain their present level of function.
The provision would have a wide impact. The Kaiser Family Foundation found that roughly 46 percent of Medicare beneficiaries suffer from at least three chronic conditions. “With access to some basic therapies, many of these patients may well be able to avoid nursing and hospital care,” said Judith Stein, director of the Center for Medicare Advocacy (CMA).
Patients who suffer from chronic conditions such as Alzheimer’s Disease, multiple sclerosis, Parkinson’s Disease, spinal cord injury, respiratory disease and contractures stand to benefit the most from the results of the settlement. Final approval of the proposed legal settlement is anticipated to come in early 2013, and implementation of the new maintenance standard would begin a year after approval is finalized. Stein called the settlement “a victory for people who need care.”
RehabCare will continue to monitor the settlement and report back as the situation develops.