Blog for John Sweeney - Elder, Wills, Estates, Trusts, Special Needs, Business, & Tax Lawyer in CT and NY

Medicare Can Now Pay For Care to Prevent Deterioration

Posted by John Sweeney | Mar 25, 2014 | 0 Comments

In the past, it has been Medicare's position that patients will be denied coverage for therapy services because they are not improving.

Fortunately, in January, they changed the rule to eliminate any requirement that improvement is necessary to receive coverage for skilled care. See the updated policy manual.

Practically, that means Medicare now will pay for skilled care such as physical therapy, nursing care and other services.  They will do it for people with chronic diseases like multiple sclerosis, Alzheimer's, or Parkinson's.  All that is necessary is the care maintain their condition and prevent deterioration.

The changes affect care from skilled professionals for physical, occupational or speech therapy, and home health and nursing home care.  It applies for patients in both traditional Medicare and private Medicare Advantage plans. Various limits and other reasons for denial of coverage still apply.

If the provider stands by the old rules and will not continue treatment because you are not improving, you should refer them to Medicare's online fact sheet about the settlement, which clearly says, “Coverage depends not on the beneficiary's restoration potential, but on whether skilled care is required.”

There is a great Article from the New York Times which goes into greater detail.

This is a big deal and allows people to get care just to prevent deterioration.

About the Author

John Sweeney

John is an experienced lawyer who helps you solve your problems. He practices Elder, Wills, Estates, Trusts, Special Needs, Business, & Tax Law in Fairfield County CT and Westchester County New York. He brings a wealth of experience in law, business, tax, insurance, and finance to arrive at practical solutions with compassion and care. Honest, direct and practical, he is focused on you and your problems. He also brings a wealth of personal experience from his own large family and aging parents.


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Elder, Wills, Estates, Trusts, Special Needs Tax & Business Law; Attorney John Sweeney

Sweeney Legal, LLC, provides legal, practical, and business counsel to Seniors, families, and businesses in the Fairfield, Connecticut area, including the communities of Bridgeport, Bethel, Brookfield, Danbury, Darien, Easton, Fairfield, New Canaan, Newtown, Norwalk, Redding, Ridgefield, Stamford, Weston, Westport and Wilton. John is also licensed in New York serving Westchester County including the towns of Bedford, Lewisboro, Mount Kisco, North Salem, Pound Ridge, and Somers.