New evidence suggests that home care agencies are not giving Medicare assistance to chronically ill people that legally qualify for it, according to an article from wuwf.org. Take the case of Colin Campbell. Now fifty-eight years old, the man was diagnosed with Amyotrophic lateral sclerosis (ALS), otherwise known as Lou Gehrig’s disease, eight years ago. The illness causes the death of the neurons responsible for voluntary muscles movement.
As his mobility declines, he needs regular assistance with basic day to day tasks such as bathing, dressing, and moving from his bed to his wheelchair. His tongue is partially paralyzed which means that swallowing is nearly impossible, forcing him to use a feeding tube. To learn more about amyotrophic lateral sclerosis, click here.
The disease means that he qualifies for Medicare coverage, but so far a total of fourteen different home care agencies have told him that he cannot use the program for home care.
This is an untrue claim. Medicare is usable for home care services, but agencies are using incentives that are meant to reward good care practices and combat fraud as an excuse to avoid helping patients like Campbell, who have long term illnesses that current medical technologies cannot improve. Changes to the rules that started recently could make things worse. Campbell now has to spend $4,000 per month in medical expenses.
Regulations stipulate that Medicare should cover home care indefinitely for patients like Campbell as long as a doctor deemed it necessary and the patient cannot leave home easily. They are not required to show improvement in their condition.
John Gillespie’s mother was also diagnosed with ALS in 2014. Since then, she switched agencies four times before finding one that would accept Medicare home coverage. For Gillespie, it took persistence, a good doctor, and an appeal of Medicare’s initial decision to deny coverage before the program could be used for her home care.
The current regulatory arrangement puts patients who need long term care at a disadvantage. Firstly, long term patients can draw the attention of auditors who could deny payments if there is suspicion of billing fraud or if they become convinced that the patient is ineligible. Medicare has done little to assuage the fears of home care agencies; nearly a third of payments from the agency were deemed improper last year. The Home Health Compare website run by Medicare makes long term patients even more burdensome for agencies. Essentially, an agency only gets a high rating on the site if patients show improvement under their care, and for people with ALS or other rare diseases, improvement is simply not possible.
