Home Health & Hospice Week

Agreement in class action suit should torpedo improvement criteria.

Get ready to do away with the notion that your patient must improve to earn Medicare coverage for home health services.

In a proposed settlement of a nationwide class-action lawsuit filed last year (see Eli's HCW, Vol. XX, No. 4), the Obama administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for home care and other post acute services, reports the New York Times.

Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for the services if they are needed to "maintain the patient's current condition or prevent or slow further deterioration," the newspaper says. The proposed settlement, negotiated with lawyers from the Justice Department and the Department of Health and Human Services, was submitted last week to the chief judge of the Federal District Court in Vermont, the Times continues. If she approves it as expected, she would have authority to enforce it for up to four years.

The changes will apply to both fee-for-service Medicare and Medicare Advantage plans, the Times says.

Access, Cost Issues In Dispute

"The agreement will expand access to care for tens of thousands of people with chronic conditions and disabilities and ease the financial strain facing these beneficiaries and their families," cheers Medicare Rights Center President Joe Baker in a release. "People with Medicare can now depend on coverage for services that treat or manage debilitating, chronic illnesses like Alzheimer's disease, multiple sclerosis and Parkinson's disease -- even if the condition is not expected to improve."

An HHS spokesperson told Reuters the proposed settlement "clarifies" existing policy. "We expect no changes in access to services or costs," she said.

But Judith Stein of the Center for Medicare Advocacy, which represented the plaintiffs, expects the change to increase Medicare's costs, she told the press.