“Medicare is Covering Skilled Maintenance Services”

The Institute for Person-Centered Care -- the first of its kind in the United States -- is designed to promote better delivery of services to frail and vulnerable people, particularly the elderly, and support advocacy and public awareness of their needs, through a program of cross-disciplinary research, education and practice development. This new interdisciplinary institute brings together researchers, educators, health care providers and community-based programs to develop and disseminate evidence-based care of the frail and aging citizens in our society.

Retiring the Medicare Improvement Standard:

This one hour and forty minute pre-recorded workshop will review and describe the implementation of the Medicare policy covering maintenance services as skilled care.  This change results from the binding settlement on January 24, 2013 of Jimmo v. Sebelius, a nation-wide class action. The new policy, effective immediately, marks a critical step forward for thousands of beneficiaries nationwide. The Centers for Medicare & Medicaid Services (CMS) will revise its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatient settings.

For decades, Medicare beneficiaries – particularly those with long-term or debilitating conditions and those who need rehabilitation services – have been denied necessary care based on the "Improvement Standard.”  This illegal practice has resulted in Medicare coverage for vital care being denied to thousands of individuals on the grounds that their condition was stable, chronic, not improving, or that the necessary services were for "maintenance only.”  The use of this illegal standard has had a particularly devastating effect on patients with chronic conditions such as Multiple Sclerosis, Alzheimer's disease, ALS, Parkinson's disease and paralysis to name a few. 

This workshop will explain what this clarification of Medicare law means and how patients can benefit and organizations can effectively bill for services provided. There is also a brief Q and A period and the exchange of potential barriers as well as opportunities at the end of the program.

Length of Program:   1 hour 40 minutes

Program Objectives:  Participants will be able to:

Understand the Medicare coverage standards for skilled maintenance therapy/nursing services that are in effect now.

Develop their facility’s or agency’s strategy for implementing the clarified Medicare coverage standards for skilled maintenance therapy/nursing services.

Facilitator:  Anthony Szczygiel, J.D. is a professor in the SUNY Buffalo Law School.  His classroom courses include Elder Law and Health Law.  Every semester, Tony also supervises the Foster Elder Law Clinic that he started in 1983.  The Clinic works closely with Legal Services for the Elderly, Disabled or Disadvantaged of WNY.  The major focus of the clinic work is legal issues related to long term care access and coverage.  As part of this work, the Clinic has handled scores of Medicare and Medicaid appeals for elderly or disabled clients.

Tony has made over 300 presentations for the New York State and local County Bar Associations, as well as other advocates and consumers.

Target Audience: Nursing Home and Home Care Agency Administrators, Therapists, Billing Staff, Community Healthcare Providers, MR/DD Specialists, Discharge Planners and Screeners/Case Managers