Two federal courts have ruled that the Obama Administration Medicare standards are too strict!

[Better Believe It]

Medicare Standards Are Too Strict, 2 Courts Find
By ROBERT PEAR
November 1, 2010

Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care.

Medicare will pay for those services if they are needed to maintain a person’s ability to perform routine activities of daily living or to prevent deterioration of the person’s condition, the courts said. Medicare beneficiaries do not have to prove that their condition will improve, as the government sometimes contends, the courts said.

The rulings are potentially significant for many people with chronic conditions and disabilities like multiple sclerosis, Alzheimer’s disease and broken hips. Skilled care may be reasonable and necessary and covered by Medicare even if the person’s condition is stable and unlikely to improve, the courts said.

The government has not said whether it intends to appeal either decision.

A group of 17 House Democrats, led by Mr. Courtney, (Joe Courtney, D-Connecticut) recently sent a letter to the Obama administration objecting to its interpretation of the law.

“Beneficiaries are frequently told that Medicare will not cover skilled services if their underlying condition will not improve,” the letter said. “For example, as people with multiple sclerosis are often not likely to improve, skilled services such as physical, occupational and speech therapies that are necessary to slow the progression of the disease, or maintain current function, are denied. As a result, these individuals’ conditions deteriorate — frequently leading to more intense, more expensive services, hospital or nursing home care.”

Read the full article at:

http://www.nytimes.com/2010/11/02/health/policy/02medicare.html?ref=us

[midnight]

1. I wonder if private insurance co. that base their decision making on medicare

standards will apply this idea that services requested do not need to prove that they improve condition in order to be obtained? This would be wonderful with those who have chronic issues.

[Better Believe It]

2. I didn't know that was even a Medicare requirement until the courts overturned it.