Mdicare long term care appeals

[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.

This is all true. But the Medicare decision is solely about who will pay the bill - Medicare or the resident. It’s not a decision regarding discharge. Discharge decisions are between the resident and the facility. But don’t think that rehab facilities won’t sue you for payment. Rehab and LTC is neither free nor a right.

[Anonymous]

What if the patient has no safe place to be discharged to? Doesn’t own a home, cannot live independently (wheelchair bound, fall risk, incontinent, needs help dressing and bathing, etc)? They qualify for Medicaid.

[Anonymous]

Anonymous wrote:What if the patient has no safe place to be discharged to? Doesn’t own a home, cannot live independently (wheelchair bound, fall risk, incontinent, needs help dressing and bathing, etc)? They qualify for Medicaid.

If they qualify for Medicaid and qualify for LTC, Medicaid should pick up payments.

[Anonymous]

Anonymous wrote:

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.

No. That's incorrect. The individual must be out of an inpatient setting (hospital or skilled nursing facility) for 60 consecutive days in order for the 100 days to reset. Then you need the 3 day QUALIFYING hospital stay. And anyway the 100 days you keep referencing is a benefit for short term skilled nursing and/or subacute rehabilitation. Long Term Care is entirely separate, financially, and absolutely NOT covered by Medicare. Perhaps you are confusing Medicare and Medicaid?

[Anonymous]

Anonymous wrote:What if the patient has no safe place to be discharged to? Doesn’t own a home, cannot live independently (wheelchair bound, fall risk, incontinent, needs help dressing and bathing, etc)? They qualify for Medicaid.

Not automatically. Still have to meet income requirements. Not owning a home doesn't always mean a person is indigent.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

No. That's incorrect. The individual must be out of an inpatient setting (hospital or skilled nursing facility) for 60 consecutive days in order for the 100 days to reset. Then you need the 3 day QUALIFYING hospital stay. And anyway the 100 days you keep referencing is a benefit for short term skilled nursing and/or subacute rehabilitation. Long Term Care is entirely separate, financially, and absolutely NOT covered by Medicare. Perhaps you are confusing Medicare and Medicaid?

If Medicare is not covering the SNF, then does the 100 reset?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

No. That's incorrect. The individual must be out of an inpatient setting (hospital or skilled nursing facility) for 60 consecutive days in order for the 100 days to reset. Then you need the 3 day QUALIFYING hospital stay. And anyway the 100 days you keep referencing is a benefit for short term skilled nursing and/or subacute rehabilitation. Long Term Care is entirely separate, financially, and absolutely NOT covered by Medicare. Perhaps you are confusing Medicare and Medicaid?

If Medicare is not covering the SNF, then does the 100 reset?

If Medicare is not covering the SNF, then the 100 isn't being used at all.

[Anonymous]

Good News. After a appeal denial, insurance approved the second appeal for continued skilled nursing care. Not sure how long it will last but feel a small amount of relief.

--OP

[Anonymous]

Anonymous wrote:Good News. After a appeal denial, insurance approved the second appeal for continued skilled nursing care. Not sure how long it will last but feel a small amount of relief.

--OP

what did you say in your appeal? my father was denied at two levels of appeal.