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Medicare Class Action Settlement to Help Thousands
By Matt O’Donnell
Thousands of Medicare patients with severe chronic illnesses will continue to receive physical and occupational therapy and other services at home or in a nursing home thanks to a class action lawsuit settlement reached earlier this week.
The proposed Medicare settlement will resolve a national class action lawsuit filed last year that challenged a longstanding Medicare policy that says patients must show improvement to keep getting rehab. Medicare advocacy groups challenged the policy as unfair to patients with chronic illnesses such as Parkinson’s, multiple sclerosis, Alzheimer’s and chronic lung disease.
“If you have a chronic condition, by definition you are not improving,” said Gill Deford, a lawyer with the Center for Medicare Advocacy and the lead attorney on the case. “Our view is that Medicare regulations were intended to allow people to maintain their health status. They don’t have to show they are getting any better. The point is to allow them not to get any worse, if possible.”
If approved, the Medicare class action lawsuit settlement will affect tens of thousands – and potentially hundreds of thousands – of patients nationally. Those who stand to benefit from the Medicare settlement include not only people with incurable conditions like Parkinson’s, but also senior citizens advancing in age. After all, how do you prove your condition is improving if you continue to get older and grow weaker?
Government lawyers denied that Medicare imposes an inflexible standard that patients must continue to improve to keep receiving rehab services, and maintain the policy change under the proposed settlement is merely a “clarification.”
The Medicare policy manual will be changed to spell out that coverage of rehabilitation services “does not turn on the presence or absence of a beneficiary’s potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care,” according to the proposed settlement.
Deford said it could be several months before the Medicare class action settlement is finalized in court, and perhaps another year before Medicare formally completes the policy change. But patients may start seeing a change sooner.
The case is Glenda Jimmo, et al. v. Kathleen Sebelius, Case No. 11-cv-17-CR, U.S. District Court, Northern District of Vermont.
[Source: The Associated Press]
Updated October 25th, 2012
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With this also include individuals with disabilities who attend Day Habilitation programs…as MassHealth regulations state that we must show active treatment, not maintenance.