According to the Hartford Courant, Connecticut congressman Joe Courtney (D-2nd) believes the functional eligibility rules are too restrictive and is asking the federal government to stop denying Medicare home health and skilled nursing care benefits to individuals whose medical conditions may not improve when they receive these services. At issue is the Centers for Medicare and Medicaid (CMS)’ interpretation of Medicare rules, which CMS believes do not allow it to pay for care that will not lead to improvements in a patient’s condition.
Late last week, a group of patient advocates, including the Connecticut-based Center for Medicare Advocacy, filed a class action lawsuit seeking to end this practice. The suit was filed in Vermont but cites cases in a number of states, including someone living in Bloomfield, CT who was denied coverage.
Two federal courts have already decided cases in a way that support’s Courtney’s position, reported the New York Times in November 2010. The Vermont and Pittsburgh courts ruled that the Obama administration’s interpretation was overly strict, and called on Medicare to pay for these services even if they are needed (1) only to maintain a person’s ability to perform routine activities of daily living or (2) to prevent deterioration in his or her condition, not improve it. These decisions are expected to help people with chronic conditions and disabilities, such as multiple sclerosis, whose conditions typically do not improve.
