News & Updates
What is an ABLE account?
The ABLE (Achieving a Better Life Experience) Act will ease financial strains faced by individuals with disabilities by making tax-free savings accounts available to cover qualified expenses such as education, housing and transportation. The ABLE Act will supplement, but not supplant, benefits provided through private insurances, the Medicaid program, the supplemental security income program, the beneficiary's employment and other sources.
An ABLE account provides individuals with disabilities the same types of flexible savings tools that other Americans have through college savings accounts, health savings accounts and individual retirement accounts. Legislation through this Act also contains Medicaid fraud protection against abuse and a Medicaid pay-back provision when the beneficiary passes away. It will eliminate barriers to work and saving by preventing dollars saved through ABLE accounts from counting against an individual's eligibility for any federal benefits program.
To read more about ABLE accounts Click Here
What is an Advance Directive?
Have you ever wondered what would happen to you if you were seriously injured or had an illness that would make you unable to communicate with medical professionals providing your care? Or what happens if family members were asked to make life-changing decisions on your behalf?
An Advance Directive is a way of making your voice heard when you can no longer communicate. This Directive allows you to appoint someone to make healthcare decisions for you or to administer or withhold treatment and procedures based on your previously stated wishes.
Settlement Reached to End the Medicare "Improvement Standard" - Skilled Maintenance Services Are Covered By Medicare
For decades, Medicare beneficiaries were denied the necessary care based on what has come to be known as the "Improvement Standard." This "Improvement Standard" had become a barrier to Medicare beneficiaries receiving necessary care. This standard especially affected those individuals with long term care needs and chronic debilitating conditions who have needed ongoing rehabilitation services.
Historically, Medicare beneficiaries were informed that Medicare will not cover their physical or occupational therapy services unless they are able to show progress. Many Medicare beneficiaries have been wrongfully denied therapy services because they "plateaued" that is, they failed to show progress. This standard became shorthand for Medicare coverage denials issued on the basis that the person's condition is chronic, stable and not improving. Medicare beneficiaries were denied therapy services for maintenance only.
In 2011, the Centers for Medicare Advocacy (CMA) filed a class action lawsuit, Jimmo et al v. Sebelius. The lawsuit alleged that the "Improvement Standard" operated as a rule of thumb to prematurely deny Medicare coverage to beneficiaries who are not showing improvement. The CMA argued that the "Improvement Standard" conflicted with the Medicare Act which provided that a person's restoration potential is not a deciding factor in determining if skilled services are needed. In reality, a person's restoration potential became the primary factor in deciding if therapy services would continue under Medicare. When challenged, providers would threaten that they would be committing Medicare fraud if they provided services to a person who was not showing progress.
The critical factor is whether the services of a skilled healthcare professional are needed and not whether the Medicare beneficiary is expected to improve. The Settlement Agreement standards apply to Medicare beneficiaries now. This means that Medicare coverage is available to Medicare beneficiaries who need ongoing therapy to maintain their condition or slow the deterioration regardless of their underlying illness, disability or injury. We understand the system and advocate for our clients whose rights are being denied.
For more information about the Settlement Agreement, visit the Centers for Medicare Advocacy at www.medicareadvocacy.org.
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