Category: Newsworthy Notes

In January, in the settlement to a class-action lawsuit filed in 2011 against the secretary of health and human services, Medicare officials updated the agency’s policy manual, the rule book for everything Medicare, to erase any idea that improvement is necessary to receive coverage for skilled care. That means that now Medicare will pay for physical therapy, nursing care and other services for recipients with chronic diseases like Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration

The settlement affects care from skilled professionals for physical, occupational or speech therapy, and home health and nursing home care, for patients in traditional Medicare as well as private Medicare Advantage plans.

For nursing home coverage, you must have a doctor’s prescription for skilled nursing home care (not custodial care), and you must have spent three consecutive midnights (72 hours) in the hospital as an “admitted”patient (observation days don’t count). Limits on the duration of Medicare nursing home coverage remain the same.

Physical and speech therapy prescribed by a doctor, provided in a nursing home or an outpatient facility, by a trained professional are subject this year to a therapy cap of $1,920. For medically necessary treatment providers can get an automatic exception to the cap until costs reach $3,700. At that point, another exception is possible after Medicare reviews medical documentation. Similarly, Occupational therapy is provided to patients with separate $1,920 and $3,700 caps, with the same exceptions.

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Updated: August 16, 2017