WE’RE GOING TO bounce around a few different things today, but allow me to begin with the one that really rubs me the wrong way: the “Jimmo” ruling.
An appropriate response at this juncture would be, “Huh?”
Let me get your heads back around this because we’ve been here before.
According to cms.gov, the U.S. District Court for the District of Vermont approved a settlement agreement Jan. 24, 2013, in the case of Jimmo v. Sebelius in which “the plaintiffs alleged Medicare contractors were inappropriately applying an ‘improvement standard’ in making claims determinations for Medicare coverage involving skilled care.”
This is about Medicare. Specifically it’s about Medicare coverage for skilled nursing facility, home health and outpatient therapy. Medicare does cover these services, based on the need for skilled care.
Maintain, slow decline
More specifically, it covers those services to maintain or slow decline as well as to improve the patient’s condition.
Get it? In other words, “not getting worse” is just as legitimate a reason to cover these things as “to get better.”
The problem was (is) that for many years, Medicare and its providers all over the country interpreted qualification for these services as the “improvement standard”: You have to be getting better in order for us to help you keep getting better. If you stop getting better, we stop the services.
No, you don’t — and a federal judge said so a while back.
Now a federal judge has said the secretary of Health &Human Services was doing a lousy job of implementing the ruling (i.e., educating providers and the public) and has ordered all manner of corrective action measures.
Corrective action measures are excruciatingly boring.
Here’s what’s important:
These services are covered by Medicare, even if their goal is to help you maintain your status quo.
You do not have to be “improving.”
And I still run into this in our counties on a regular basis: providers denying continuing one of these services because they’re thinking “improvement standard” — it isn’t malicious; it’s ignorant.
If this happens to you or yours, request a reconsideration/appeal immediately, and don’t back down. “Not getting worse” matters.
Here’s something different: I hope it’s old news by now, but another phone scam has been making the rounds for a while.
New phone scam
This one alters your caller ID to make it appear as though the call is coming from the Department of Health &Human Services (HHS) Office of Inspector General (OIG) Hotline: 800-447-8477 (800-HHS-TIPS).
The hope being that being shrouded in such a mantle of legitimacy, we’ll just spew forth all kinds of personal information, allowing the bad guys to drain bank accounts, etc.
Sadly, some folks do.
It’s a scam.
I can absolutely assure you that, on the off chance the federal HHS OIG really wanted to get a hold of you, they would not use their hotline number to do it, so don’t answer.
If you do answer, hang up.
If you choose to report it (which is not a bad idea), you can go to spoof@oig.hhs.gov or call (yes, I’m serious) 800-447-8477 and bask in the irony.
You live your life your way, but here’s my rule for me: I don’t give out any personal information (e.g., Social Security number, etc.) to anybody on the phone (or through email) unless I initiated the interaction. And even then, I can be annoyingly choosy.
It’s too bad that that’s where we are, but that’s where we are.
About documents
Last one, because it just came up:
Recently (well, a couple of weeks ago, which qualifies as “recently,” if you’re me), I went on about advance care planning, advance directives and durable powers of attorney for health care.
The question that has come to me a few times since, in various combinations of words, is, “Do I have to do that?”
Answer: No.
There is no law, regulation or rule of any sort that requires anyone to have any of these documents in place. Period.
If you don’t have them, and if you experience a medical issue in which you are unable to speak for yourself or make your own medical decisions, then the medical professionals involved will make the decisions based on law, ethics and any input they get from any family members they can find.
If that’s OK with you, then you don’t need to do anything, and generally speaking, heroic measures will be applied.
There’s nothing wrong with that.
I’ll make an observation that I’ve shared before: Everything really is just fine, as long as it is.
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Mark Harvey is director of Clallam/Jefferson Senior Information &Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing harvemb@dshs.wa.gov.
