By Gill Deford, Margaret Murphy, and Judith SteinDiagnosed three years earlier with Amyotrophic Lateral Sclerosis ("ALS," or otherwise known as "Lou Gehrig’s Disease"), 68-year-old Eileen Prendergast was suddenly informed by her home health agency … [Read more...] about How the 'Improvement Standard' Improperly Denies Coverage to Medicare Patients with Chronic Conditions – text of article printed in Clearinghouse Review, Vol. 43, No. 9-10, Jan-Feb. 2010
Chronic Conditions
Medicare for People with Chronic Conditions
People with chronic conditions and long-term illnesses are too often denied Medicare coverage on the grounds that they will not improve, need "maintenance services only," have "plateaued" or are "chronic and stable". Taken together, these reasons … [Read more...] about Medicare for People with Chronic Conditions
The "Improvement Standard" is a Barrier to Necessary Care
Mrs. P, 68 years old, was diagnosed with Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's Disease) five years ago. She now needs a wheelchair, cannot stand on her own, needs assistance to move from bed to wheelchair, and is losing … [Read more...] about The "Improvement Standard" is a Barrier to Necessary Care
Medicare Help for Beneficiaries With HIV/AIDS
The month of December began with World AIDS Day, an international day of action on HIV and AIDS. When advising Medicare beneficiaries with the diagnoses of HIV and AIDS, be aware that Medicare covers a wide array of services, for those living with … [Read more...] about Medicare Help for Beneficiaries With HIV/AIDS
Important Health Care Lacking for Older People
Older Americans are not getting six key preventive services or appropriate treatment for hypertension that clinical practice guidelines indicate they generally should receive, according to two studies recently published in the Journal of the American … [Read more...] about Important Health Care Lacking for Older People
ADAPs to Offer Free Hepatitis C Drugs
Patients enrolled in AIDS Drug Assistance Programs (ADAPs) with chronic hepatitis C will now have free access to a new combination drug therapy. Schering-Plough Corporation announced in late February that it will provide a new combination … [Read more...] about ADAPs to Offer Free Hepatitis C Drugs
MS Drug, Tysabri, Suspended
On February 28, 2005 the manufacturers of Tysabri, Biogen Idec and Elan Corporation, announced the voluntary suspension of the Multiple Sclerosis drug from the market and from all clinical trials. According to the companies’ press … [Read more...] about MS Drug, Tysabri, Suspended
Illegal “Improvement Standard” for SNF Coverage Terminated
Over the years, contractors that review Medicare claims have denied coverage for Medicare services inappropriately on the grounds that the beneficiary's condition will not improve. The Center for Medicare Advocacy, through individual appeals and … [Read more...] about Illegal “Improvement Standard” for SNF Coverage Terminated
Medicare For People With Alzheimer’s Disease And Other Chronic Conditions
As the New York Times reported on March 31, 2002 (p.1), Medicare advocates have been successful in convincing the Centers for Medicare and Medicaid Services (CMS) to loosen Medicare's denial practices for people with Alzheimer's disease and … [Read more...] about Medicare For People With Alzheimer’s Disease And Other Chronic Conditions
Recommendations for a Coordinated Care Benefit in the Medicare Program
The Center for Medicare Advocacy's recent conference on adding a coordinated care benefit to the traditional Medicare program achieved a high level of agreement on the importance of changing attitudes as well as institutional factors to improve … [Read more...] about Recommendations for a Coordinated Care Benefit in the Medicare Program