Call Us Toll Free 877-475-1101|

Expanded Skilled Nursing Facility Medicare Coverage During the Covid-19 Pandemic

The COVID-19 pandemic has been particularly devastating for nursing homes and their residents. Aside from the tragically disproportionate loss of life, care for surviving residents has been delayed or interrupted due to infection, facility lockdowns, or other health system disruptions. As a result, the Centers for Medicare & Medicaid Services (CMS) has waived two limitations on Medicare Part A skilled nursing facility (SNF) coverage during the coronavirus pandemic: The 3-day qualifying hospital stay requirement; and The 100-day benefit period.  However, CMS treats the two SNF coverage expansions differently from [...]

By |2021-03-04T08:21:58-05:00March 4th, 2021|Aging, Assisted Living, Blog, Elder Care, Medicaid, Medicare, Nursing Home|

Will I Lose My House if I Go on Medicaid?

One question I am almost always asked: Will I lose my house if I go on Medicaid? Throughout my legal career – beginning as a public interest attorney in Philadelphia through my work at Rothkoff Law Group – I have given many community presentations on advanced-care planning and long-term care. This is the one question I am almost always asked. First, to clarify, Medicaid is a health insurance program administered by the states and jointly funded by the states and federal government. Medicaid programs vary by state, but generally [...]

By |2020-10-13T12:44:31-04:00October 13th, 2020|Blog, Medicare, Nursing Home|

Reviewing Your Health Insurance During Medicare Open Enrollment

As Fall approaches, everyone looks forward to the crisp weather, pumpkin spice and Halloween, but here at Rothkoff Law Group, it also means preparing for the Medicare open enrollment period. Open enrollment in 2020 will run October 15, 2020 through December 7, 2020. Any changes made during this time will take effect for 2021. While many may ultimately not need to make any changes at all, it is a good reminder to assess your needs for the upcoming year. During open enrollment, you can make the following changes: Change [...]

By |2020-08-31T09:49:27-04:00August 31st, 2020|Blog, Medicaid, Medicare|

Does Medicare Pay for Nursing Home Care?

Many people are under the misperception that Medicare will pay for nursing home care. Medicare, the federally funded health insurance received upon attaining 65 years of age, will only pay for skilled nursing care under certain circumstances and then only for a limited period of time. When you have been discharged from a hospital stay of at least three days to a Medicare-approved skilled nursing facility, and if you require “skilled” care for treatment of the condition for which you were hospitalized, Medicare will pay 100% of the cost [...]

By |2020-07-28T10:57:44-04:00July 28th, 2020|Blog, Medicaid, Medicare, Nursing Home|

Federal Court Orders Appeal Rights on “Observation Status” Issue for Certain Medicare Hospital Patients

Medicare beneficiaries who have been denied coverage for nursing home stays because their time in the hospital was changed from “inpatient” to “observation care” can now appeal to Medicare for reimbursement, a federal judge in Hartford, Conn., ruled last week. The decision opens the door to medically necessary services in skilled nursing facilities that Medicare beneficiaries might otherwise have to forgo because they cannot afford to pay for it themselves. The distinction between being labeled a hospital “inpatient” versus being placed on observation status is important because Medicare only [...]

By |2020-08-21T11:49:41-04:00March 30th, 2020|Blog, Medicare|

The New Medicare Patient Driven Payment Model (PDPM): What Does It Mean for Nursing Home Residents?

As an advocate for nursing home residents, Rothkoff Law Group strives to educate our clients, their families and consumers about regulatory changes that may affect the care their loved ones receive.   In October 2019, the Centers for Medicare and Medicaid Services (CMS) implemented a new payment model for skilled nursing facilities (SNFs), the Patient-Driven Payment Model (PDPM).  PDPM is described by CMS as a patient-driven care model  that focuses on the diagnoses and characteristics of the patient rather than the services, including the therapy services, provided to them. The [...]

By |2020-08-21T12:18:51-04:00February 3rd, 2020|Blog, Medicare, Nursing Home|

The Need for Medicare Dental Coverage

Medicare has done so many wonderful things for older Americans since its inception in 1965.  However, to date, traditional Medicare does not cover dental care. Traditional Medicare does not cover preventive dental services like exams, cleanings, and x-rays.  Nor does it cover basic or major restorative services and items like fillings, extractions, root canals and dentures.  When such dental work must be performed in a hospital setting due to the severity of the procedure or the patient’s underlying medical condition or clinical status, Medicare will cover the costs of [...]

By |2020-08-21T12:45:58-04:00December 9th, 2019|Blog, Elder Care, Medicare|

Are Nursing Home Residents Receiving Less Therapy?

Medicare’s new reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM),changed reimbursement rules and the financial incentives for SNFs, effective October 1, 2019.  As a result, nursing home skilled nursing residents who are receiving rehabilitation care may be receiving less therapy than prior to October 1, 2019. Prior to Oct. 1, 2019, Medicare reimbursed nursing homes for therapy based on the number of minutes provided to each patient, up to 720 minutes a week. The goal is to help patients regain mobility and the ability to [...]

By |2020-08-21T12:48:32-04:00December 2nd, 2019|Blog, Medicare|

Assistance with Medicare Skilled Nursing Appeals

Medicare coverage of nursing home care depends on a resident’s need for skilled nursing and/or therapy, not the resident’s potential for improvement. However, too many nursing home residents continue to be denied skilled services on the basis of an “Improvement Standard,” which was firmly rejected by the court-approved settlement in Jimmo v. Sebelius.  In order to help nursing home residents and their families challenge these unfair denials, the California Advocates for Nursing Home Reform (CANHR) have prepared an in-depth discussion on filing expedited or fast-track Medicare appeals and offers guidance on [...]

By |2020-08-24T09:50:37-04:00November 11th, 2019|Blog, Medicare|

Changes To Medicare Nursing Home Covered Care

Pursuant to the Center for Medicare Advocacy, on October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system for Medicare-covered nursing home stays—the “Patient Driven Payment Model” (PDPM). PDPM creates new financial incentives for nursing homes and new challenges for nursing home residents. One of the biggest challenges for residents under PDPM is access to skilled therapy. The Center for Medicare Advocacy and the Long Term Care Community Coalition have developed a new Issue Alert to help residents and their families understand the implications of PDPM [...]

By |2020-08-24T09:54:50-04:00October 21st, 2019|Blog, Medicare|

Update on the Jimmo Case – Medicare Coverage for Skilled Nursing Care

The 2013 Settlement in Jimmo v. Sebelius confirmed that Medicare coverage should be determined based on a beneficiary’s need for skilled care (nursing or therapy), not on the individual’s potential for improvement. Unfortunately, more than six years after the Settlement’s approval, Medicare beneficiaries and providers across the country are still having significant problems with the implementation of the Settlement. The Center for Medicare Advocacy with support form the John A. Hartford Foundation, has compiled an Issue Brief to provide Medicare stakeholders with an overview of the Jimmo Settlement, what [...]

By |2020-08-24T10:45:20-04:00July 1st, 2019|Blog, Medicare|

Reflections on the 6th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture

On May 9, 2019, members of the Rothkoff Law team including Jerry Rothkoff, Bryan Adler, Roxanne Crowley, Kaitlin Dirxx, and Chelsea Ganssle traveled to Washington, DC to attend the Center for Medicare Advocacy’s sixth annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture at the Kaiser Family Foundation.  The theme of the day was Health Care as a Human Right: Medicare’s Role in Making it a Reality. The Summit convened advocates, leading experts, and policy-makers to discuss access to quality health care for all, the challenges and [...]

By |2020-08-24T10:59:09-04:00May 20th, 2019|Blog, Medicaid, Medicare|

The Start of the Presidential Debate Regarding Long-term Care Coverage

During the 2016 Presidential campaign, a major issue effecting virtually all American families was noticeably absent from the debate – long-term care coverage.  Hopefully, that is about to change heading into the 2020 Presidential campaign.  Senator Bernie Sanders and his Democratic colleagues in the House  have included a long-term care benefit as part of the “Medicare for All” bill.  I am not stating that Senator Sanders or the Democrats solution to long-term care coverage in this country is the correct solution.  In fact, the Democrats have not proposed how [...]

By |2020-08-24T11:16:25-04:00March 11th, 2019|Blog, Medicare|

2019 Elder Law Numbers

The Centers for Medicare and Medicaid Services (CMS) has released the new Medicare premiums, deductibles, and co-payments for 2019:• Basic Part B premium: $135.50/month (was $134.00 in 2018)• Part B deductible: $185 ($183.00 in 2018)• Part A deductible: $1,364 (was $1,340 in 2018)• Co-payment for hospital stay days 61-90: $341/day (was $335 in 2018); Co-paymentfor hospital stay days 91-150: $682/day (was $670 in 2018)• All costs for each day beyond 150 days• Skilled nursing facility co-payment, days 21-100: $170.50/day (was $167.50 in 2018)Also, note that individuals with annual incomes [...]

By |2020-08-25T11:37:59-04:00December 31st, 2018|Blog, Medicaid, Medicare|
Load More Posts
Go to Top