Last week, Medicare entered into an agreement to settle a lawsuit brought by a Vermont-based woman named Glenda Jimmo in conjunction with the Center for Medicare Advocacy and other plaintiffs, according to Forbes.com. As part of the settlement, Medicare has agreed to expand skilled nursing cares and rehabilitation benefits for some individuals with chronic disease. But what this settlement does not include is an expansion of long-term care benefits.
No long-term care benefits
Medicare has never provided coverage for long-term care, which can be a common misconception. Medicare covers only skilled nursing care, which includes physical and occupational therapy as well as complex nursing care, such as IV therapies or wound care. And Medicare only provides coverage for skilled care for a short duration, after which it becomes the patient’s responsibility to continue paying for care out-of-pocket. Only if another qualifying hospital stay occurs can an extension of skilled nursing benefits occur.
Long-term care, on the other hand, is also known as custodial care. Medicaid will cover long-term care in some cases, but not all.
Clarifying vague language on maintenance therapy
This settlement won’t change the duration of coverage for skilled nursing care, which has a maximum of 100 days. It will, however, clarify vague language. Providers have been reluctant to continue providing skilled care to patients who were not continuously improving as a result of that care, fearing that payment would be denied. But now, patients are eligible to receive skilled care even if that care doesn’t cause improvement but allows the patient to maintain her current health status.
Skilled nursing care must be deemed necessary by a medical professional or based on an individual assessment, but doctors will no longer have to certify that patients will improve as a result.
Forbes.com points out that these changes could actually end up saving the Medicare program money in the long run. Ongoing therapies can help patients maintain their current health status, preventing more frequent hospitalizations.
While a judge must enter the ruling for it to become official, Medicare will already begin to implement these changes. Still, it could take months for the changes to be in full effect.