Administration proposal would ease Medicare coverage for SNF stays

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Federal health officials have agreed to changes in Medicare coverage rules that would make it easier for beneficiaries with chronic conditions to qualify for nursing home stays, outpatient therapy and home healthcare services, according to reports.

Currently, in order for Medicare to cover skilled nursing facility stays, beneficiaries must demonstrate potential for functional improvement. This requirement makes it difficult for people disabled by chronic conditions such as Alzheimer's, multiple sclerosis, Parkinson's disease, spinal cord injuries and others to qualify for coverage.

However, as part of a proposed settlement of a class-action lawsuit, the administration has agreed that Medicare now will pay for services that are needed to “‘maintain the patient's current condition or prevent or slow further deterioration,' regardless of whether the patient's condition is expected to improve,” the New York Times reported.

The change in policy is related to a class-action lawsuit (Jimmo v. Sebelius), which argues that denials of Medicare coverage for chronic conditions cause harm to beneficiaries. The majority of Medicare beneficiaries have at least two chronic conditions, according to the Center for Medicare Advocacy. The changes would apply to traditional Medicare plans and Medicare Advantage plans.

While Medicare advocacy and provider groups hail the proposed changes, the administration has not said how the government would pay for the added coverage. Experts and legal officials with the Department of Health and Human Services acknowledge the cost of this reversal could be substantial. Others suggest it could save the government money since physical therapy and home health are typically less expensive than care delivered in hospitals and nursing homes, the newspaper noted.

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