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Medicare
Tuesday, September 9, 2014
By: Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho
People covered by Medicare occasionally want to complain to Medicare to contest hospital discharge orders, nursing home care, home health services and hospice programs, all paid for by Medicare.
Effective August 1, 2014, the toll-free phone numbers to call have been changed for filing a Medicare complaint. If you are an Idaho Medicare beneficiary and you wish to file a complaint about the quality of care, or to file an appeal, call this toll-free number: (877) 588-1123.
Each state has a quality improvement organization. The formal name is “Quality Improvement Organization (Beneficiary and Family Centered Care).” The purpose of this organization is to work with providers on issues such as reducing hospital readmissions, prevent infections and review beneficiary complaints. In the past, there has been a perception that a conflict of interest existed because the prior organization that handles complaints also advised the providers (hospitals, nursing homes, etc.) With this new system, Medicare beneficiary appeals and complaints will go to independent regional contractors. Lavanta, the contractor that covers Idaho, is based in Maryland and handles the Northeastern and Western states.
Health care is an important part of estate planning. Save this phone number with your health information or paste it on the back of your Medicare card.
Tuesday, June 10, 2014
By: Susan M. Graham, Certified Elder Law Attorney, Senior Edge Legal, Boise, Idaho
Picture yourself in the hospital - you are 65 years old. You have been there for a week receiving care and treatment. You are then discharged to a skilled nursing or rehabilitation facility. Next you find out you were not “admitted” to the hospital, but instead were there just for “observation.” What difference does it make? You received the same level of care. The difference is huge. If you are there for “observation”, Medicare (the health insurance for people over age 65) and your supplemental health insurance will not pay for your care in the hospital and in the facility. It is a crazy rule that cheats Medicare participants and costs them breathtaking out-of-pocket expenses that can range from $6,000 to $45,000.
I am a member of the National Academy of Elder Law Attorneys, Inc. (NAELA). They are working with other groups to change the law. The following is a recent article provided by NAELA. Unfortunately it appears that changing the law to eliminate the difference between “admitted” and “observation” is unlikely in this legislative session.
“The Improving Access to Medicare Coverage Act (H.R. 1179/S. 569) would change the admission standard to count outpatient “observation” time spent in a hospital toward the three-day inpatient hospital stay required before Medicare pays for subsequent skilled nursing facility or rehabilitation services. Support for this legislation is growing. The bill has garnered the support of 144 cosponsors in the House and 25 cosponsors in the Senate. The next big hurdle is to find a health-related legislative vehicle to use to pass it through Congress. During a lame duck session, there are few potential legislative vehicles.
Judith Stein, Founder and Executive Director of the Center for Medicare Advocacy and NAELA Past President, wrote the latest NAELA: Eye on Elder and Special Needs Issues article, “Observation Stays in the Hospital: The Impact on Medicare Beneficiaries.” In the article, Stein discussed the increased use of observation status, the costly implications of not changing this policy, and how to take action.
On May 20, 2014, Toby Edelman from the Center for Medicare Advocacy testified in front of the House Ways and Means Subcommittee on Health. The congressional hearing focused on current hospital issues in the Medicare program, with an emphasis on the Centers for Medicare and Medicaid Services (CMS) two-midnights policy, short inpatient stays, outpatient observation stays, auditing, and appeals. Read Health Subcommittee Chairman Kevin Brady’s hearing announcement.”[1]
[1] Advocacy Update, May 29, 2014, Published by the National Academy of Elder Law Attorneys, Inc. (NAELA)
Thursday, November 1, 2012
By Joseph S. Karp
Florida Bar Certified Elder Law Specialist
Nationally Certified Elder Law Attorney
Florida and New York Bar
A sweeping change in Medicare policy may greatly help beneficiaries with chronic conditions who need skilled nursing and rehabilitation.
In the past, Medicare would continue to cover skilled nursing care and short-term rehabilitation, like physical and speech therapy, only if the patient demonstrated that he had the potential to improve as a result of treatment. Obviously, those with chronic conditions like Alzheimer's Disease, heart disease, Parkinsons, Lou Gehrigs disease, arthritis - in other words, those who could not meet the so-called improvement standard -- were most impacted by this rule. (In fact, the so-called "improvement standard" was technically never a part of Medicare law; it had simply become the de facto standard used by Medicare decision makers.)
Now, a federal court has ruled that the improvement standard cannot be used to deny Medicare coverage for skilled nursing care and rehabilitation. The settlement in the class action lawsuit Jimmo v. Sibelius requires Medicare to cover skilled nursing and therapy even if it just maintains a person's medical condition or prevents further deterioration. The proposed settlement was reached in federal district court on Oct. 16, 2012.
However, it's critical to note these important caveats:
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The case does not change the maximum number of days of skilled care Medicare covers per benefit period. Medicare will pay 100% for a maximum of 100 days, and only if it follows a hospital stay or stay in a rehab facility.
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The case does not impact whatsoever on long-term, custodial nursing care, which is still not covered by Medicare, but may be covered under certain circumstances and with proper planning byFlorida Medicaid.
Details on the Medicare rule change here.
Thursday, November 1, 2012
By Joseph S. Karp
Florida Bar Certified Elder Law Specialist
Nationally Certified Elder Law Attorney
Florida and New York Bar
A sweeping change in Medicare policy may greatly help beneficiaries with chronic conditions who need skilled nursing and rehabilitation.
In the past, Medicare would continue to cover skilled nursing care and short-term rehabilitation, like physical and speech therapy, only if the patient demonstrated that he had the potential to improve as a result of treatment. Obviously, those with chronic conditions like Alzheimer's Disease, heart disease, Parkinsons, Lou Gehrigs disease, arthritis - in other words, those who could not meet the so-called improvement standard -- were most impacted by this rule. (In fact, the so-called "improvement standard" was technically never a part of Medicare law; it had simply become the de facto standard used by Medicare decision makers.)
Now, a federal court has ruled that the improvement standard cannot be used to deny Medicare coverage for skilled nursing care and rehabilitation. The settlement in the class action lawsuit Jimmo v. Sibelius requires Medicare to cover skilled nursing and therapy even if it just maintains a person's medical condition or prevents further deterioration. The proposed settlement was reached in federal district court on Oct. 16, 2012.
However, it's critical to note these important caveats:
-
The case does not change the maximum number of days of skilled care Medicare covers per benefit period. Medicare will pay 100% for a maximum of 100 days, and only if it follows a hospital stay or stay in a rehab facility.
-
The case does not impact whatsoever on long-term, custodial nursing care, which is still not covered by Medicare, but may be covered under certain circumstances and with proper planning byFlorida Medicaid.
Details on the Medicare rule change here.
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