Federal courts in Pennsylvania and Vermont have ruled that Medicare standards are too stringent when it comes to deciding if a patient is eligible for skilled nursing home care or home health.
The Federal District Court in Pittsburgh disagreed with Medicare’s decision to terminate coverage of an 81-year-old woman who required skilled nursing care, physical therapy and occupational therapy in a nursing home after a hip replacement. After five weeks of treatment, Medicare ended her coverage claiming that she had not improved and wasn’t likely to. In the Vermont case, Medicare terminated coverage of a 66-year-old woman who was getting home health services after suffering from two strokes. The federal court there ruled that Medicare improperly denied the woman coverage. Her lawyers argued, successfully, that home therapy was needed to keep her condition from deteriorating, The New York Times reported._
Following these two rulings, 17 House Democrats wrote President Obama a letter asking for more relaxed standards. The letter pointed out that many chronic conditions, such as multiple sclerosis, require regular therapy to prevent further deterioration.