If you are in the State of New Jersey and would like to discuss your estate plan, our team at Willis Law Group LLC is here to provide you with any assistance that you may need. To schedule a consultation, we encourage you to give our main office a call at (877) 296-2575 or attend one of our free educational workshops throughout New Jersey.
A new payment method for Medicare providers is making it harder for some home health care patients to receive certain services such as physical, occupational or speech therapy.
On January 1 of this year, the Federal Centers for Medicare and Medicaid Services (CMS) instituted a new way of paying home health care providers, calling it the Patient-Driven Groupings Model (PDGM). Previously, provider payments were based on the amount of therapy that was delivered. The PDGM requires payments to be based on a complicated formula that takes into account a patient’s medical condition, the extent to which the patient is impaired and whether the patient was hospitalized. Further, CMS now pays providers in 30-day periods of care, rather than 60-day periods like it had done before.
As a response to this new system, providers are now slashing therapy services. In a recent study, Kaiser Health News found that therapists are being asked to decrease services or are incorrectly telling patients that services are not being covered. Many therapists are being laid off as well. There are also fewer incentives for home health providers to treat patients who need long-term therapy.
While providers have reacted to the new payment system by cutting services, CMS sent a letter to providers reiterating that actual coverage for services has not changed. As long as a patient meets the requirements for receiving home health care under Medicare regulations, the patient should get home health care services, and that includes therapy. CMS maintained that home health care agencies should not ignore physician orders.
If you encounter coverage problems, contact the Willis Law Group LLC to have a conversation with our team of elder law specialists. You can reach our firm directly by calling (877) 296-2575.