Medicare Throws Out "Improvement Standard"

skilled_maintenanceA recent change in Medicare's skilled maintenance policy marks a big step forward for beneficiaries who need therapeutic care (physical, occupational, or speech therapy) to maintain their current condition or prevent decline of health. After the January 24th settlement of the Medicare Improvement Standard case Jimmo v. Sebelius, Medicare is required to cover "skilled maintenance care" to maintain a patient's current health status and prevent further deterioration of the patient's functional abilities. This is great news for seniors and disabled individuals who need skilled care. Before last month's court settlement, a patient's qualification for therapy or other skilled care hinged on the Medicare Improvement Standard. Medicare's policy was that a beneficiary's skilled care services would only be covered if those services were likely to improve the patient's condition. That is to say that once the patient had "plateaued," Medicare would refuse to cover therapy and other skilled care.The downside of this coverage policy was that it disregarded the value of skilled care in maintaining a patient's current condition and preventing further deterioration. In many cases, even though full recovery may not be possible, skilled maintenance services can prevent or delay the decline of an individual's condition, which in turn may reduce the long-term cost of care while improving the quality of life. And the monetary savings don't just help the patient and his or her family: by avoiding the expense of covering repeated hospitalizations and other costly long-term care needs, Medicare may well see its overall expenditures shrink.The Jimmo settlement marks a major policy change for Medicare, and it goes into effect immediately. That means that if you or your loved one are denied skilled maintenance care based on the Improvement Standard, you should inquire about coverage under Medicare's new policy.For more information about this and other Medicare policies, get in touch with us at Elder Law of East Tennessee. We'll be happy to answer your questions and point you in the right direction.

Amelia Crotwell, JD

Amelia Crotwell, founder and managing partner at Elder Law of East Tennessee, has guided families through long-term care and special needs challenges for nearly two decades. Specializing in Life Care Planning and special needs trusts, Amelia also collaborates across all areas of elder law, including wills, trusts, Medicare, Medicaid, probate, and veterans benefits planning. Certified as an Elder Law Attorney since 2011, she is president-elect of the Life Care Planning Law Firms Association and co-chair of their strategic planning committee. Amelia is deeply involved in the Special Needs Alliance and a prominent member of the National Academy of Elder Law Attorneys. She played a key role in founding the Tennessee chapter of NAELA, serving as its first president. A member of the Tennessee Bar Association and past chair of its Elder Law Section Executive Council, Amelia also dedicates time to pro bono work and community education. She earned her J.D., summa cum laude, from the University of Tennessee College of Law and teaches Elder Law there as an adjunct professor since 2018.

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