Vermont Class-Action Settlement – Provides Coverage For Certain Home Health Patients

Many Medicare Administrative Contractors (MAC) have policies that home health patients must have a likelihood of improvement or they would not be covered for home health, nursing home or therapy.  The chief judge of Vermont’s federal district court approved a settlement with the Federal government to change the Medicare rules to cover services if they are needed to maintain the patient’s current condition or to slow any further deterioration.  The Federal government has agreed to make changes to the Medicare manual to show coverage of nursing and therapy is not based on the presence or absence of a patient’s potential for improvement, but would be based on the patient’s need for skilled care. 

CMS must make changes to the Medicare Benefit Policy Manual and other policy, guidelines and instructions.  This will include educating the Medicare Administrative Contractors who currently are making coverage decisions.  The actual settlement is effective now, but we encourage home health agencies to proceed cautiously.  Look for future updates from CMS and from you Medicare Administrative Contractor.