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The Politics of Health Care

Medicare Settles Lawsuit: Many Will Gain Access to Services

Published December 11, 2012 11:19 AM by Michael LaMagna
If any readers have patients Medicare refused to pay for skilled nursing, home care or other outpatient benefits because their condition was "stable, chronic, not improving or that the necessary services were for maintenance," keep reading because there is some very good news.

In early October, CMS settled a class action lawsuit filed by the Center for Medicare Agency and Vermont Legal Aid. According to the settlement, CMS will reverse course and allow Medicare to pay for services "necessary for the performance of a safe and effective maintenance program." In addition, CMS will no longer deny claims because a Medicare beneficiary wouldn't be able to achieve complete independence or because they can no longer return to their prior functioning level.

Under the agreement, CMS will also set up an appeals process, similar to the process currently in place, in which a beneficiary can appeal a denial for a claim, all the up to an impartial Administrative Law Judge. It is expected the new policy revision will enable thousands to gain access to needed skilled care and allows those Medicare providers to continue needed services, in particular, to those with chronic conditions, including Alzheimer's, Parkinson's and multiple sclerosis.

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such. Michael LaMagna is a partner at The Law Office of Michael LaMagna, LLC, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Email him at Mlamagna@nyandctlaw.com, call him at 914-534-1048 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information. You can also follow Attorney LaMagna on Twitter@michaellamagna1.

posted by Michael LaMagna


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