by Lois G. Tager, M. Ed., CSA
Director of Geriatric Care Management, Litherland, Kennedy & Associates, APC, Attorneys at Law
A “Quiet “change in Medicare is often one where physicians and health care providers are informed but not the general senior population. Susan Jaffe of the New York Times recently wrote about a change of which we believe seniors and all beneficiaries should be aware. Previously, a patient could be denied coverage for physical therapy and occupational therapy because they were no longer improving and had “plateaued”.
In January, however, Medicare officials updated the agency’s policy manual, the official rule book for Medicare, to “erase any notion that improvement is necessary to receive coverage for skilled care”. Medicare will now pay for physical therapy, nursing care and other services for beneficiaries with chronic diseases like multiple sclerosis, Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration.
These changes occurred due to a class-action lawsuit filed in 2011 against Kathleen Sebelius, the secretary of health and human services, by the Center for Medicare Advocacy, Vermont Legal Aid on behalf of four Medicare patients and five national organizations. The settlement affects care from skilled professionals for physical, occupational or speech therapy, home health, nursing care and for patients in both traditional Medicare and private Medicare Advantage plans.
This change may have a far-reaching impact on seniors who want to avoid institutional care. People with chronic conditions have the possibility to receive care and remain in their homes. For nursing home coverage you would still need a doctor’s order. A doctor’s order for intermittent care is required for out-patient therapy as well. This will allow skilled professionals to come to the home for care such as physical therapy, occupational therapy, social work services or nursing care.
If one is unable to get services, California residents can contact the Health Services Advisory Group of California, Inc. (HSAG) by visiting their website at http://www.hsag.com/home.aspx or calling 1-800-841-1602. HSAG will be able to provide details regarding how to appeal.
ABOUT THE Litherland, Kennedy & Associates, APC, Attorneys at Law
Roy W. Litherland is an attorney whose practice emphasizes elder law and estate planning. Roy has practiced law in the greater Bay Area for the last 38 years and is certified as a legal specialist in Estate Planning, Trust and Probate Law by the California State Bar Board of Legal Specialization. In addition to his extensive legal background, Roy was also previously licensed as a Certified Public Accountant. Although Roy has an extensive background in accounting, he retired his license to practice as a CPA to devote his time and energy entirely to the practice of law, specializing in estate planning, trusts, Medi-Cal planning, and probate. Roy is a noted speaker on living trusts, Medi-Cal Planning, and estate planning. He is a member and designated Fellow of the American Academy of Estate Planning Attorneys, an organization that fosters excellence in estate planning.
Lois Tager, Director of Geriatric Care Management, holds a Masters in Education, specializing in counseling and psychotherapy from Providence College, a Bachelor of Science in Education from Boston University and is a Certified Senior Advisor and Geriatric Care Manager. Lois worked in the Bay Area as an instructor in healthcare at West Valley College and maintained a private practice in counseling for many years. Lois has worked with the Alzheimer’s Association for the past 13 years as a facilitator for caregiver groups. She published “Sundown Syndrome: A Primer” in the CSA Journal of the Society of Certified Senior Advisors, CSA Journal 46, 2010. She authored a column “Ask Lois” for the Alzheimer’s Association Monterey County Newsletter and wrote numerous articles. She is a former columnist for AOL’s Campbell Patch, Senior Corner, an on-line news column.
The Litherland, Kennedy & Associates, APC, Attorneys at Law is a member of the National Academy of Elder Law Attorneys and the California Advocates for Nursing Home Reform.
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