When will skilled care be paid for by Medicare?

September 25, 2011

By Attorney David Engler

Skilled nursing facility care will be paid by Medicare when your ward or parent needs daily skilled care that cannot be provided in the community or on an outpatient basis. The benefits are the cost or partial cost of rehab in a nursing home facility. Medicare part A will pay for the first 20 days at the full patient cost, and up to 80 more days with a co-pay. The issue that a guardian is often confronted with is whether the patient is benefitting from the care being received. There are horror stories of older patients receiving care that could not possibly benefit them. With the federal government focused on saving money in the entitlement areas like Medicare, be sure that there will be increased scrutiny on the payment for skilled care and whether it is needed.

That is where the guardian has to become the advocate for the patient. You need to observe the changing condition of the patient and ideally the improvement. There will be an ongoing assessment of rehabilitation goals. One of the manners in which this is determined is improvement in gait. The patient does not have to be considered curable for Medicare to pay.

Services can be provided at home through a Medicare certified home health agency. The patient will need to have the doctor write a plan of care. This plan of care should be discussed by the guardian with the doctor and make sure that it is updated every two months.

Attorney David Engler
Phone: 330-729-9777
http://www.DavidEngler.com Attorney Engler’s website
Areas of Practice: Family Law, Elder Law, Domestic Relations, Bankruptcy, Criminal

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