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 Change Coming in Medicare Home Health Care 
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Joined: Tue Aug 28, 2012 8:48 pm
Posts: 6
Post Change Coming in Medicare Home Health Care
My elderly husband has been diagnosed with LBD two years ago. As his CG, I have found reading the LBD Forums very helpful. Although I have not yet written an introductory post, I promise that I will. Presently, we are getting no outside help. My son and I are caring for him.

I'm writing today about an item I first read in the "NYTimes." There has been a settlement to a class action lawsuit, Jimmo v. Sebelius; the settlement agreement was approved 24 Jan. 2013. The Center for Medicare Advocacy and the Alzheimer Association are among the co-defendents. This settlement seems to mean that Medicare coverage is now available for skilled services which "maintain" an individual's condition. This means that no longer do skilled services rendered at home be required to show "improvement" in the patient's condition to be covered by Medicare. See http://www.medicareadvocacy.org.

My thought is that LBD patients can be well served by the types of therapy and nursing service available at home. Have any of you all chanced upon this change in Medicare?

Best wishes, Coral


Sat Mar 30, 2013 1:05 pm
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Joined: Sat Jan 03, 2009 2:59 pm
Posts: 1978
Post Re: Change Coming in Medicare Home Health Care
Dear Coral,
First let me welcome you here and say thank you for posting this as I am sure many here will find it helpful in their own journey !

_________________
Irene Selak


Sat Mar 30, 2013 3:33 pm
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Joined: Wed May 02, 2012 8:26 pm
Posts: 55
Post Re: Change Coming in Medicare Home Health Care
My husband started having PT & OT at home after being released from the hospital. (One week was in the hospital & one week was in patient rehab, then home with the home service.) Now one of the evaluators is saying his PT ended this past week. I am fighting to get the maintenance program with them. Most of the ones I have talked with don't even have a clue about this change which really isn't a change at all but the way it was always supposed to be done by Medicare, I will post what happens & if I have to appeal the decision.

Susieg


Sat Mar 30, 2013 10:31 pm
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Joined: Tue Aug 28, 2012 8:48 pm
Posts: 6
Post Re: Change Coming in Medicare Home Health Care
Susieg,

If you go to the Center for Medicare Advocacy website:
http://www.medicareadvocacy.org/medicar ... tandard-2/
on the first page look for links "Self-Help Packets" and "Frequently Asked Questions." The Self-Help link will be useful to you, I hope.

I really haven't tried, as I have just found this information. My husband had therapy and home health aid two years ago, but it soon ended. We have been caring for his every need since then, including incontinence. Good luck! Let us know your results.

Best wishes, Coral


Sun Mar 31, 2013 12:16 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Change Coming in Medicare Home Health Care
susieg wrote:
My husband started having PT & OT at home after being released from the hospital. (One week was in the hospital & one week was in patient rehab, then home with the home service.) Now one of the evaluators is saying his PT ended this past week. I am fighting to get the maintenance program with them. Most of the ones I have talked with don't even have a clue about this change which really isn't a change at all but the way it was always supposed to be done by Medicare, I will post what happens & if I have to appeal the decision.

Susieg


Actually, Medicare home health services never did cover maintenance visits [I was a home health case manager for many years]. The qualifier was that it had to be either an acute condition, e.g., a recent hospital visit, or an exacerbation of an chronic condition. The change described above, if it happens, will benefit many but I'm not sure how it will be paid for.

My husband gets what is called 'restorative care' in the SNF. It is of immeasurable value as the range of motion exercises keep him from getting contractures.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sun Mar 31, 2013 12:40 am
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Joined: Tue Aug 28, 2012 8:48 pm
Posts: 6
Post Re: Change Coming in Medicare Home Health Care
I would like to make a correction, please, in my first post.

"The Center for Medicare Advocacy and the Alzheimer Association are among the co-plaintiffs." They are not "defendants."
This is their class action law suit. Yes, I am not a lawyer!

Sorry, Coral


Sun Mar 31, 2013 11:06 am
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Joined: Wed May 02, 2012 8:26 pm
Posts: 55
Post Re: Change Coming in Medicare Home Health Care
No, it wasn't covered previously but the court ruled that it should have been because that was always the intent...according to the court ruling.

Susieg


Sun Mar 31, 2013 7:41 pm
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