Good news about Medicare rules on LE treatment

carol57

Bob Weiss, the wonderful LE advocate who helps with insurance denials of LE and garment coverage, just posted on another forum, giving the link to a news story:

https://www.nytimes.com/2012/10/23/us/politics/settlement-eases-rules-for-some-medicare-patients.html?ref=us&_r=0

Here's the first part of the story:

Tens of thousands of people with chronic conditions and disabilities may find it easier to qualify for Medicare coverage of potentially costly home health care, skilled nursing home stays and outpatient therapy under policy changes planned by the Obama administration.

In a proposed settlement of a nationwide class-action lawsuit, the administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.

Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve.

Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services “does not turn on the presence or absence of an individual’s potential for improvement,” but is based on the beneficiary’s need for skilled care.

I don't know if Bob had a hand in nudging this settlement along, but I would not be surprised if his was one of the voices calling for the change.

Now we'll see how this translates to reality!

Edited -- I cannot change the thread title, but I should have said 'LE treatment' instead of 'garments.' It's not clear that the story suggests garments will be covered, but indeed, this is a good change that helps Bob and others move the conversation in that direction.

Anonymous

Carol, that's terrific. I will have to read the article. Thanks for posting. Your comments made me think about my friend who is a nurse practitioner for a couple of nursing homes. She sees patients to offset the number of times the doctor has to see them. Anyway, I had quizzed her about how many of her patients had LE and she said none of them. (Yes, she needs to take your course!) I had also asked if any of her patients had compression garments or were wrapped. She said no. She said if they had LE then it was under control. Well, now I am wondering whether Medicare has just not been paying for garments or wrapping, which is why none of them have garments or get wrapped. Goodness knows, she couldn't see that my hand and arm had any swelling, so I wouldn't count on her to recognize LE in any of her patients.

Binney4

Carol, what a coup! I'm reposting this to the RIBP thread. Our RIBP gals have had their LE therapy cut off because the chances for improvement in arm function were nil. This is an amazing step forward. What a surprise!
Binney