After a class action lawsuit, Medicare has changed their standards for benefits for chronic conditions. Under the previous Medicare standard, patients had to show that they had a likelihood of medical or functional improvement before they could receive Mediare assistance with professional nursing or physical therapy sessions.
Regulations and the law did not require an expectation of improvement, but the Medicare manual and guidelines used by many Medicare contractors reflected this requirement.
Under the new guidelines, Medicare recipients will no longer be expected to show a likelihood of improvement but rather that treatment will “maintain the patient’s current condition or prevent or slow further deterioration”. This new benchmark means that many seniors suffering from untreatable chronic conditions may have access to benefits that can help them afford needed treatments including in home care.
Common conditions faced by many seniors such as Alzheimer’s, Multiple Sclerosis, Parkinson’s, and even spinal chord injuries could possibly benefit from this decision.
With so many chronic conditions that may be maintained – or have deterioration slowed – rather than improved, these benefits can help many seniors and families. that might otherwise have not been able to afford needed care without assistance.