Getting Screwed by Home Health Providers

Getting home health care via Medicare can be a helluva struggle – I’ve run into instances when care has been denied patients who aren’t expected to improve -e.g. cancer patients- even though the law explicitly says such sufferers are eligible. Of course, if you challenge the demi-gods running home care you’ll be on their shit-list forever so be forearmed with a lawyer who understands…
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Home care agencies often wrongly deny Medicare help to the chronically ill

Recipients are unable to use their Medicare for home care and instead pay out of pocket for that service
Susan Jaffe, Kaiser Health News01.22.2018•2:58 AM This article originally appeared on Kaiser Health News.
https://www.salon.com/2018/01/22/home-care-agencies-often-wrongly-deny-medicare-help-to-the-chronically-ill_partner/

Colin Campbell needs help dressing, bathing and moving between his bed and his wheelchair. He has a feeding tube because his partially paralyzed tongue makes swallowing “almost impossible,” he said.

Campbell, 58, spends $4,000 a month on home health care services so he can continue to live in his home just outside Los Angeles. Eight years ago, he was diagnosed with amyotrophic lateral sclerosis, or “Lou Gehrig’s disease,” which relentlessly attacks the nerve cells in his brain and spinal cord and has no cure.

The former computer systems manager has Medicare coverage because of his disability, but no fewer than 14 home health care providers have told him he can’t use it to pay for their services.

That’s an incorrect but common belief. Medicare does cover home care services for patients who qualify, but incentives intended to combat fraud and reward high quality care are driving some home health agencies to avoid taking on long-term patients such as Campbell, who have debilitating conditions that won’t get better, according to advocates for seniors and the home care industry. Rule changes that took effect this month could make the problem worse.

“We feel Medicare coverage laws are not being enforced and people are not getting the care that they need in order to stay in their homes,” said Kathleen Holt, an attorney and associate director of the Center for Medicare Advocacy, a nonprofit, nonpartisan law firm. The group is considering legal action against the government.

Federal law requires Medicare to pay indefinitely for home care — with no copayments or deductibles — if a doctor ordered it and patients can leave home only with great difficulty. They must need intermittent nursing, physical therapy or other skilled care that only a trained professional can provide. They do not need to show improvement. Those who qualify can also receive an aide’s help with dressing, bathing and other daily activities. The combined services are limited to 35 hours a week.

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