“Improvement Standard” can’t cut off Medicare nursing home days
Medicare coverage depends not on the beneficiary’s restoration potential, but on whether skilled nursing home care is required.
In a decision released February 2, 2017, the federal judge overseeing the Settlement Agreement in the Medicare "Improvement Standard" case (Jimmo v. Burwell) ordered the Secretary of Health & Human Services to carry out a Corrective Action Plan to remedy the Department's noncompliance with the Settlement.
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You may be confronted by hospital or nursing home staff, who tell you that Medicare will not continue to pay for care. But there are many Medicare Regulations that protect your rights to continued coverage if you need skilled care.
Medicare regulations say "the determination of whether skilled nursing care is reasonable and necessary must be based solely upon the beneficiary's unique condition and individual needs, without regard to whether the injury is acute, chronic, terminal, or expected to last a long time."
Links to Medicare manual are at:
http://masshealthhelp.com/html/medica...
If you live in Hampden County, Massachusetts, call us to schedule an educational meeting if you need to protect these important rights to health care services that Medicare does cover. (413) 567-5600