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 The Settlement Agreement: See previous page by Sue 
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Joined: Sat Oct 06, 2007 4:28 pm
Posts: 781
Location: LA
Post The Settlement Agreement: See previous page by Sue ... ment/Print

If this does not open, let us know and I will send the entire article.


"See this lady she's 85 but she's nice", This is the way my husband, Mr B., introduced me in 2006 to the people only he knew. Death due to pneumonia. Lewy Body Dementia diagnosed post mortem at Mayo Clinic in Jacksonville Florida.

Fri Dec 06, 2013 2:09 am

Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3441
Location: Vermont
Post Re: The Settlement Agreement: See previous page by Sue
Wow - very interesting Dorothea. Thanks for posting - I'm sure this will be helpful to many people. Lynn

Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.

Fri Dec 06, 2013 8:41 am

Joined: Fri Mar 08, 2013 10:17 pm
Posts: 24
Location: NH
Post Re: The Settlement Agreement: See previous page by Sue
Here's another useful link from which tells how to work an appeal under jimmo v. sebelius. This is one of my major references as well as a fact sheet from medicare itself that I was/am planning to use. It's very clear that skilled care to prevent further deterioration can be covered. For me and my mom, the key statement (from the fact sheet) is "Conversely, coverage in this context would not be available in a situation where the beneficiary's care needs can be addressed safely and effectively through the use of nonskilled personnel."

Thus my question what is skilled. Not an easy question even for the therapists. As I said in the other post, our pt said it was a teaching function only. I tended to disagree.

I thought I might base my argument for coverage on the medicare rule that allows coverage for "therapeutic exercises which must be performed by or under the supervision of the qualified physical therapist, due to either the type of exercise employed or the condition of the patient". (Medicare benefit policy manual 40.2.2)

I'd be interested if anyone else has pursued this and hope this info helps anyone who might want to.

SUe ... tSheet.pdf ... d-denials/

Fri Dec 06, 2013 6:16 pm

Joined: Mon Nov 25, 2013 7:33 pm
Posts: 53
Location: Pennsylvania
Post Re: The Settlement Agreement: See previous page by Sue
Extremely helpful information. thank-you for posting!

Marian, daughter of mom [82] diagnosed with LBD November 2013 after 7 years of a textbook course of this disease. Passed on January 26, 2014 following a week of home hospice care.

Sat Dec 07, 2013 5:17 pm
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