Mdicare long term care appeals

[Anonymous]

If you successfully appeal a LT care benefit denial of coverage, do they extend the care by X days? Does it continue until the situation changes?

[Anonymous]

I do not think there are any circumstances where Medicare covers long term care more 100 days (per hospitalization). After that it is Medicaid if you meet the requirements, private pay or long term care insurance.

[Anonymous]

Medicare does not cover LTC.

[Anonymous]

Anonymous wrote:Medicare does not cover LTC.

Yes up to 100 days per year after a hospital stay.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Medicare does not cover LTC.

Yes up to 100 days per year after a hospital stay.

It’s short term rehabilitation and they take that seriously - there must be a specific issue related to the reason for hospitalization where there is a reasonable expectation that therapy will result in improvement. There is a mandated schedule for the staff from various departments to review progress and your loved one will be discharged if their condition isn’t changing for the better.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare does not cover LTC.

Yes up to 100 days per year after a hospital stay.

It’s short term rehabilitation and they take that seriously - there must be a specific issue related to the reason for hospitalization where there is a reasonable expectation that therapy will result in improvement. There is a mandated schedule for the staff from various departments to review progress and your loved one will be discharged if their condition isn’t changing for the better.

Not true...a supreme court decision says improvement is not required to continue

http://www.protectingseniorsnews.com/medicare-rehab-and-failure-to-improve/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare does not cover LTC.

Yes up to 100 days per year after a hospital stay.

It’s short term rehabilitation and they take that seriously - there must be a specific issue related to the reason for hospitalization where there is a reasonable expectation that therapy will result in improvement. There is a mandated schedule for the staff from various departments to review progress and your loved one will be discharged if their condition isn’t changing for the better.

Not true...a supreme court decision says improvement is not required to continue

http://www.protectingseniorsnews.com/medicare-rehab-and-failure-to-improve/

NP. Regardless, it still doesn’t pay for LTC. LTC is housing and physical care. Medicare pays for rehab. The goal can be improvement or necessary to prevent status quo or regression. But it doesn’t pay for LTC.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Medicare does not cover LTC.

Yes up to 100 days per year after a hospital stay.

It’s short term rehabilitation and they take that seriously - there must be a specific issue related to the reason for hospitalization where there is a reasonable expectation that therapy will result in improvement. There is a mandated schedule for the staff from various departments to review progress and your loved one will be discharged if their condition isn’t changing for the better.

Not true...a supreme court decision says improvement is not required to continue

http://www.protectingseniorsnews.com/medicare-rehab-and-failure-to-improve/

NP. Regardless, it still doesn’t pay for LTC. LTC is housing and physical care. Medicare pays for rehab. The goal can be improvement or necessary to prevent status quo or regression. But it doesn’t pay for LTC.

But up to 100 days resetting after a 3 day hospital stay.

[Anonymous]

My father went to rehab after 2 months in the hospital following a stroke. He was bedbound for so long he couldn’t even sit up when he left hospital. Medicare paid for 2 weeks of rehab and then cut him off. He still couldn’t walk or get around by himself yet they deemed him improved enough. I appealed but was still denied. Ended up having to private pay and spend down assets to qualify for Medicaid so that he could get LTC.

[Anonymous]

Anonymous wrote:My father went to rehab after 2 months in the hospital following a stroke. He was bedbound for so long he couldn’t even sit up when he left hospital. Medicare paid for 2 weeks of rehab and then cut him off. He still couldn’t walk or get around by himself yet they deemed him improved enough. I appealed but was still denied. Ended up having to private pay and spend down assets to qualify for Medicaid so that he could get LTC.

I work in a nursing home. This happens all the time. And they love to send the cutoff notice at 5:30 on a Friday/ Christmas Eve/ insert holiday here. They do this because you only have 24 hours to appeal. There is not always appropriate staff there to receive the notice and notify the family in time to appeal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My father went to rehab after 2 months in the hospital following a stroke. He was bedbound for so long he couldn’t even sit up when he left hospital. Medicare paid for 2 weeks of rehab and then cut him off. He still couldn’t walk or get around by himself yet they deemed him improved enough. I appealed but was still denied. Ended up having to private pay and spend down assets to qualify for Medicaid so that he could get LTC.

I work in a nursing home. This happens all the time. And they love to send the cutoff notice at 5:30 on a Friday/ Christmas Eve/ insert holiday here. They do this because you only have 24 hours to appeal. There is not always appropriate staff there to receive the notice and notify the family in time to appeal.

This is from a law firm protecting the elderly: "If a resident or their family members receive an eviction notice from a nursing home, the typical time frame for the completion of an eviction is 30 to 60 days. It is important to make sure that the notice includes the reason the resident is being discharged or transferred, the eviction date, as well as the location where the resident will be going (if the eviction is a transfer). An eviction notice should also include paperwork about the right to appeal the eviction as well as the right to a formal hearing process and legal counsel."

Not sure what state you are in but I've never heard of anything less than 30 days.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My father went to rehab after 2 months in the hospital following a stroke. He was bedbound for so long he couldn’t even sit up when he left hospital. Medicare paid for 2 weeks of rehab and then cut him off. He still couldn’t walk or get around by himself yet they deemed him improved enough. I appealed but was still denied. Ended up having to private pay and spend down assets to qualify for Medicaid so that he could get LTC.

I work in a nursing home. This happens all the time. And they love to send the cutoff notice at 5:30 on a Friday/ Christmas Eve/ insert holiday here. They do this because you only have 24 hours to appeal. There is not always appropriate staff there to receive the notice and notify the family in time to appeal.

This is from a law firm protecting the elderly: "If a resident or their family members receive an eviction notice from a nursing home, the typical time frame for the completion of an eviction is 30 to 60 days. It is important to make sure that the notice includes the reason the resident is being discharged or transferred, the eviction date, as well as the location where the resident will be going (if the eviction is a transfer). An eviction notice should also include paperwork about the right to appeal the eviction as well as the right to a formal hearing process and legal counsel."

Not sure what state you are in but I've never heard of anything less than 30 days.

It's not an eviction notice/ notice of dc or transfer. It's a fax from Medicare saying rehab services are no longer covered.
They can stay, but Medicare will not cover it, so usually they apply for Medicaid or pay privately.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My father went to rehab after 2 months in the hospital following a stroke. He was bedbound for so long he couldn’t even sit up when he left hospital. Medicare paid for 2 weeks of rehab and then cut him off. He still couldn’t walk or get around by himself yet they deemed him improved enough. I appealed but was still denied. Ended up having to private pay and spend down assets to qualify for Medicaid so that he could get LTC.

I work in a nursing home. This happens all the time. And they love to send the cutoff notice at 5:30 on a Friday/ Christmas Eve/ insert holiday here. They do this because you only have 24 hours to appeal. There is not always appropriate staff there to receive the notice and notify the family in time to appeal.

This is from a law firm protecting the elderly: "If a resident or their family members receive an eviction notice from a nursing home, the typical time frame for the completion of an eviction is 30 to 60 days. It is important to make sure that the notice includes the reason the resident is being discharged or transferred, the eviction date, as well as the location where the resident will be going (if the eviction is a transfer). An eviction notice should also include paperwork about the right to appeal the eviction as well as the right to a formal hearing process and legal counsel."

Not sure what state you are in but I've never heard of anything less than 30 days.

And there are 5 levels of appeal. First level is just a a warm up. I am nit sure they do anything before level three.

[Anonymous]

24 hours? No way.

Suggest those interested seek out information from reliable sources when it comes to Medicare/Medicaid rights, such as this one from the American Council on Aging:

https://www.medicaidplanningassistance.org/nursing-home-evictions/

The Nursing Home Reform Act (NHRA) of 1987 set federal guidelines...

When a facility is discharging a resident, there are certain procedures that must be followed.

The nursing home facility must provide a written notice of discharge to the resident and their family or legal guardian / representative. To be very clear, this notice cannot be given verbally. The written notice must include the following information, and if it is not included, the eviction notice is not valid.

-The reason for discharge. Remember, under federal law, there are only 6 reasons that a nursing home resident can be legally discharged.

-To where (the location) the resident will be discharged.

-The right and instructions to appeal and contact information of the long-term care ombudsman in one’s area.

The written notice must be received a minimum of 30 days (but may be up to 60 days) prior to the discharge date. The only exception is in the case of an emergency.

A summarization of the nursing home resident’s physical and mental status must be prepared.

A discharge plan must be written up by the nursing home. Via this plan, the nursing home must make certain the nursing home resident has a place in which to move (near family and loved ones, if possible), and summarize the care and / or services the individual will receive following discharge.

[Anonymous]

Anonymous wrote:24 hours? No way.

Suggest those interested seek out information from reliable sources when it comes to Medicare/Medicaid rights, such as this one from the American Council on Aging:

https://www.medicaidplanningassistance.org/nursing-home-evictions/

The Nursing Home Reform Act (NHRA) of 1987 set federal guidelines...

When a facility is discharging a resident, there are certain procedures that must be followed.

The nursing home facility must provide a written notice of discharge to the resident and their family or legal guardian / representative. To be very clear, this notice cannot be given verbally. The written notice must include the following information, and if it is not included, the eviction notice is not valid.

-The reason for discharge. Remember, under federal law, there are only 6 reasons that a nursing home resident can be legally discharged.

-To where (the location) the resident will be discharged.

-The right and instructions to appeal and contact information of the long-term care ombudsman in one’s area.

The written notice must be received a minimum of 30 days (but may be up to 60 days) prior to the discharge date. The only exception is in the case of an emergency.

A summarization of the nursing home resident’s physical and mental status must be prepared.

A discharge plan must be written up by the nursing home. Via this plan, the nursing home must make certain the nursing home resident has a place in which to move (near family and loved ones, if possible), and summarize the care and / or services the individual will receive following discharge.

Again. It's not a discharge from the facility.