A very important ruling came out February in the Jimmo vs. Sebelius argument. It clarified that improvement of function is not a requirement for Medicare reimbursement. Rather it's the need for skilled services that determines whether a claim is reimbursable. If a skilled service is required to maintain function or prevent decline, then according to CMS it's reimbursable.
This is incredible news to those who struggle with chronic and/or progressive conditions! For those with MS, Parkinson's, ALS, and even COPD, they no longer have to suffer through a remission in order to receive services that may prevent, or slow, their deterioration. From a public health point of view, this is brilliant preventive action.
Unfortunately I've heard stories of clinics, skilled nursing facilities and home care agencies still discharging people because "they're not making progress." In some cases that may be legitimate, but I'm sure others include those who could still benefit from maintenance interventions. As professionals, we'll be charged with sorting out who needs skilled maintenance and who simply needs an aide to assist them with walking or doing a home program. Based on some of my ADVANCE colleague bloggers' tales of pressure to keep inappropriate people on caseload, I can see this becoming a bigger challenge now.
It's good to know that we're empowered to give the right care, to the right people and be confident of our ability to be paid for it.