Thousands of Medicare recipients with chronic conditions - such as Alzheimer's disease, multiple sclerosis and brain injury - may soon have an easier time getting badly needed home-health care, nursing care and therapy.
That's because of a settlement in a nationwide class action suit that removes the requirement that patients getting these services must show "improvement" in their condition. This guideline shift, reported yesterday, would mean these services would be covered for Medicare recipients who need them to maintain a level of functioning or prevent further deterioration, even if they aren't showing signs of improvement.
According to the New York Times, the proposed settlement agreed to by the Obama administration has been submitted to Christina C. Reiss, the chief judge of the Federal District Court in Vermont. She is expected to approve the agreement and will be able to enforce it for four years. The agreement applies to the traditional Medicare program and to private Medicare Advantage plans, including those 65 and older and those under age 65 who have disabilities.
The settlement would make a marked difference for those with disabilities or suffering from chronic illnesses such as Alzheimer's disease, Parkinson's disease, ALS, lung disease. As these are chronic and often debilitating conditions, they are often not likely to improve. But home health assistance with activities of daily living and crucial physical, occupational, speech and other therapies can help individuals maintain a level of strength and functioning. These services can enable independence and prevent health crises and problems such as falls or an inability to remain in their own home.
While the changes in coverage could cost the government more in at-home nursing and in-home services, experts say they could be offset by cost savings over the long-term due to prevention of more costly repeat hospitalizations, nursing home and other services.