By Mark Harvey
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.
This is about Medicare coverage for skilled nursing, home health and outpatient therapy services — and Medicare does cover these services, based on need. But, more specifically, it covers those services to maintain or slow decline, as well as to improve the patient’s condition.
In other words, “not getting worse” is just as legitimate a reason to cover these things as “to get better.”
The problem is that for many years, Medicare and its providers all over the country interpreted qualification for these services under 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.
But that’s not right — and a federal judge said so, awhile back.
Now, another federal judge has said the secretary of Health & Human Services was doing a lousy job of implementing that ruling (i.e., educating providers and the public), and has ordered all manner of “corrective actions.”
Such 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 on a regular basis in our counties: providers denying continuation of one of these services because they’re thinking in terms of the “improvement standard.” It isn’t malicious; it’s ignorant.
If this happens to you or yours, request a reconsideration or appeal immediately, and don’t back down. “Not getting worse” matters.
Don’t fall for it
Something different: I hope it’s “old news” by now, but another phone scam has been making the rounds for a while. This one alters your caller ID to make it appear the call is coming from the Department of Health & Human Services Office of Inspector General Hotline: 800-447-8477. Shrouded in such a mantle of legitimacy, they try to get folks to spew forth all kinds of personal info, allowing the bad guys to drain bank accounts, etc. Sadly, some fall for it.
It’s a scam. I can absolutely assure you that, on the off-chance that the federal HHS OIG really wanted to get hold of you, they would not use their hotline number to do it; so don’t answer — or hang up.
If you choose to report it (which is not a bad idea), you can go to spoof@oig.hhs.gov or call the hotline (yes, I’m serious) and bask in the irony.
You live your life your way, but here’s my personal rule: I don’t give out any personal info (Social Security number, etc.) to anybody on the phone (or e-mail) unless I initiated the interaction — and even then, I can be annoyingly choosy. It’s too bad that’s where we are, but that’s where we are.
Advance care follow-up
Last item, because it just came up: A couple of weeks ago, I went on about advance care planning, and advance directives, and durable powers of attorney for health care, and blah blah blah. 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 as needed. 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.
Mark Harvey is the director of information and assistance for the Olympic Area Agency on Aging. He can be reached by email at harvemb@dshs.wa.gov; by phone at 360-532-0520 in Aberdeen, 360-942-2177 in Raymond, or 360-642-3634; or through Facebook at Olympic Area Agency on Aging-Information & Assistance.
