Big Medicare Change Widens Coverage
Nursing patients now won't need to show potential to improve
By Matt Cantor,  Newser User
Posted Oct 23, 2012 9:55 AM CDT
New Medicare rules will allow some patients to receive expanded coverage.   (Shutterstock)

(Newser) – In order to receive coverage for therapies like skilled nursing, many Medicare beneficiaries have for decades had to show potential for improvement in their condition. But the Obama administration's settlement of a lawsuit is poised to change all that, the New York Times reports. The result is a big change to Medicare rules: It will cover the services so long as they "maintain the patient’s current condition or prevent or slow further deterioration." The Medicare manual will reflect that such coverage "does not turn on the presence or absence of an individual’s potential for improvement."

"As the population ages and people live longer with chronic and long-term conditions, the government’s insistence on evidence of medical improvement threatened an ever-increasing number of older and disabled people," says an expert, noting that those with diseases like Alzheimer's and multiple sclerosis are likely to benefit. The decision follows a lawsuit by multiple elderly plaintiffs who were denied coverage. The settlement was organized by the Justice and Health departments, and is set for approval by a federal judge. It's unclear how much the changes will cost the US, but they could be expensive, notes the Times.
 

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