Medicare recipients with chronic conditions can no longer be turned down for home health services provided by skilled nurses and therapists, according to a recent settlement between the federal government and consumer advocates. Home care and other long term care providers benefit as well. An excerpt:
To receive this coverage, patients must meet specific requirements. First, a doctor must prescribe care from a nurse or therapist. Patients in skilled-nursing facilities also must demonstrate a need for daily services from a nurse or therapy five times a week, says William Dombi, vice president for law at the National Association for Home Care and Hospice.
To secure coverage for home health care, Medicare requires a patient to be homebound, which typically means the individual needs help moving about from a device (like a wheelchair) or a person. A doctor must approve a “plan of care” every 60 days that includes the services of a nurse or physical or speech therapist. In addition, the patient must contract with a home health agency certified by Medicare.
In Medicaid news, California may cut reimbursements to providers who accept Medi-Cal, according to a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit. Providers face a 10 percent cut. No doubt the decision will make the primary care physician shortage even worse and impact other states. With the expansion of Medicaid under the health care reform law, the situation could reach a crisis point. An excerpt:
Lynn S. Carman, an attorney for a group of pharmacies, said the decision would be costly for providers, worsen the doctor shortage and would be appealed.
“If this decision stands it will not only destroy the Medicaid program in California, but it will destroy the Obamacare program for millions of Americans who are now being shoved into the Medicaid program under the Affordable Care Act,” Carman said.
“They will not be able to obtain quality healthcare or access to services because providers cannot provide services at less than what it costs to furnish them,” Carman said.
