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Medicare improvement standard eliminated

10-29-2012 - A new development may greatly help Medicare beneficiaries with chronic conditions who need skilled nursing and rehabilitation. 

In the past, Medicare would continue to cover skilled nursing care and short-term rehabilitation, like physical and speech therapy, only if the patient demonstrated that he had the potential to improve as a result of treatment. Obviously, those with chronic conditions like Alzheimer's Disease, heart disease, Parkinsons, Lou Gehrigs disease, arthritis - in other words, those who could not meet the so-called improvement standard -- were most impacted by this rule. (In fact, the so-called "improvement standard" was technically never a part of Medicare law; it had simply become the de facto standard used by Medicare decision makers.)

As a result of a nationwide class action suit, Jimmo v. Sibelius, a federal court has ruled that the improvement standard cannot be used to deny Medicare coverage for skilled nursing care and rehabilitation. Medicare must cover skilled nursing and therapy even if these services just maintain a person's condition or prevents further deterioration.  The proposed settlement was reached in federal district court on Oct. 16, 2012.

It's important however not to confuse skilled nursing care with custodial, long-term nursing care. Medicare provides no benefits whatsoever for long-term care. Under some circumstances, and with the proper planning, Medicaid may cover long-term care.

Also, note that the case does not change the maximum duration of Medicare benefits for skilled care. The maximum number of days covered remains 100, and only if the skilled care follows a stay in the hospital or in a rehabilitation facility.

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