The Centers for Medicare & Medicaid Services (CMS) issued new regulations on November 17th regarding coverage for home health services. The new regulations clarify Medicare coverage for home health services, including physical therapy, … [Read more...] about New Medicare Home Health Regulations: Improvement is Not Required to Obtain Coverage
The Improvement Standard
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 other … [Read more...] about Medicare for People with Alzheimer's Disease and other Chronic Conditions
Two Federal Courts Reject "Improvement Standard" for Denying Medicare Coverage
Within a month of each other, two federal district courts have rejected the Center for Medicare & Medicaid Services' (CMS) beleaguered Medicare "Improvement Standard," thereby adding to the chorus of federal judges who have found the standard … [Read more...] about Two Federal Courts Reject "Improvement Standard" for Denying Medicare Coverage
The Medicare Improvement Standard: 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 … [Read more...] about The Medicare Improvement Standard: A Barrier to Necessary Care
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
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
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
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