Some Medicare beneficiaries have trouble getting extended nursing and therapy services

Apr 30 2014

Under a 2012 court settlement, the Department of Health and Human Services agreed to relax rules that said seniors could get these services only if they continued to improve. But many providers are still unaware of the new regulations.

Reuters:  New Medicare Coverage Of Long-Term Care Off To Rocky Start
Under the 2012 settlement of Jimmo v. Sebelius, the U.S. Department of Health and Human Services agreed to relax Medicare's requirements for coverage of skilled nursing and therapy services in institutional or home care settings. Prior to the settlement, Medicare's policy was to cover skilled nursing care only when patients had demonstrated medical potential to improve. Starting this year, the key criterion for coverage is a demonstrated need for skilled care -- even if the patient isn't expected to improve. ... That should be good news for the Klaibers, a retired couple living in Marstons Mills, Massachusetts, on Cape Cod. But Diane Klaiber instead finds herself embroiled in a coverage dispute with Robert's healthcare provider that underscores the rough start for the new Medicare rules (Miller, 4/29).

In other Medicare news -

Modern Healthcare:  Health Centers In Line For Medicare Boost Under New Pay Model
Medicare will increase payments to federally qualified health centers by as much as 32% while scrapping the fee-for-service model for one that gives the facilities a bundled rate for each patient encounter. On Oct. 1 the CMS will begin transitioning some 8,900 FQHCs to a new prospective payment system under a final rule issued late Tuesday. The health centers get enhanced Medicare reimbursement for providing care to underserved populations. Some of them, however, are wary of the new payment system, which was called for in the Patient Protection and Affordable Care Act (Dickson, 4/29).

USA Today: Some Chiropractors Making Big Medicare Adjustments
More than 36,000 chiropractors were paid nearly $500 million by the federal government in 2012, making chiropractors one of the largest groups of Medicare providers. And one chiropractor in Brooklyn topped the list, receiving more than $1 million that year alone. Alexander Khavash, who works in Brooklyn out of a rented office, received nearly twice the Medicare payments than any other practitioner in his field, according to data released this month by the Department of Health and Human Services (O'Donnell, Hoyer and Alcindor, 4/29).