The Chief Judge of Vermont’s U.S. District Court today gave her approval for an “improvement standard” settlement that could lead to more long-term care in the home health setting and open the benefit to patients who were previously denied coverage.
 
The settlement was first proposed by the Obama administration in October to settle a class action lawsuit by Medicare beneficiaries.
 
At issue in the suit was whether CMS contractors can deny claims for patients because their condition isn’t improving.
 
“With the settlement now officially approved, [CMS] is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatients settings,” says the Center for Medicare Advocacy in Willimantic, Conn., in a Jan. 24 press release. The center helped litigate the case on behalf of beneficiaries.
 
The release also notes that the settlement applies effective immediately. “We encourage people to appeal should they be denied Medicare [coverage] for skilled maintenance nursing or therapy because they are not improving,” says Judith Stein, the center’s executive director.
 
 
Prepare for the possibility of more maintenance services by learning how to document medical necessity when you sign up for “Open the door to management and evaluation payments.”