Why is it so difficult for providers to keep up with changes in standards and rules? Someday, I'm going to do a post on how the sheer persistence of habit produces rampant discrimination...
Some home health care providers believe that chronically ill patients who stand no chance of getting better don’t qualify for Medicare coverage—but they’re mistaken.
A 2013 settlement in the court case Jimmo v. Sebelius put that “improvement standard” to rest. As set by that case, Medicare does cover skilled nursing and therapy services, including in-home care, to maintain a patient’s current condition or prevent a slow decline. Simply put, a patient’s improvement is not a condition for Medicare coverage.
Still, some home health agencies wrongfully deny Medicare-covered services to chronically ill people specifically because their conditions won’t improve, according to a Jan. 17 report from NPR and Kaiser Health News. One such case is that of Colin Campbell, a 58-year-old Los Angeles resident with Lou Gehrig’s disease who spends nearly $4,000 on home health care per month.
Although Campbell has Medicare coverage, 14 home health care agencies told him they couldn’t treat him, according to the report. Some agencies told him Medicare would only cover rehabilitation, while others said Medicare didn’t cover home health care at all. They’re both wrong.