Jun 3, 2014

Medicare Improvement Standard no longer applies, but many are unaware of new guidelines

As I reported in my October 29, 2012 post, Medicare beneficiaries who do not meet the "improvement standard" can no longer be denied coverage for skilled nursing care or rehabilitation services in institutions or at home. These services are now covered even if they simply help a patient maintain his/her current level of functioning, or slow further deterioration. The policy change  grew out of the settlement of the case of Jimmo v. Sibelius in 2012, and has particular significance for those with chronic conditions like Alzheimer's and Parkinsons.

However, many beneficiaries are unaware of the policy change. So are many health care providers, despite dissemination of the information by the Centers for Medicare and Medicaid Services. Reuters, for example, recently cited the case of 78-year-old Robert Klaiber of Massachusetts. Klaiber suffers from Parkinsons and had no idea that Medicare would continue to cover the cost of the massage therapy that eases his symptoms. After finding out about the new Medicare guidelines accidentally from a friend, he approached his health care provider. The provider was not familiar with elimination of the improvement standard, either.

If your claim for services has been denied based on the now-defunct improvement standard, check out the Center for Medicare Advocacy's "self help packets." These packets provide information and guidelines to help you appeal a denial. Access the packets here.

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