In the seemingly never ending quest to find a way to reduce Medicare and Medicaid costs, the administration has come up with a new scheme that is turning rehabilitation facilities into ghost towns and putting Texas seniors at risk. This scheme has not taken the form of a law change. Rather, it has taken the form of a “pilot program” to modify the way in which hospitals make the determination about whether to send a senior to rehabilitative care. The catch phrase of this scheme is, “medical necessity.” It carries with it the suggestion that the patient is really ready to go home, and the suggestion that there is no alternative for the inexperienced family caring for a senior.
Bear in mind that the actual law for when a senior on Medicare is entitled to rehabilitation has not changed. Most seniors who have a 72-hour stay in hospital are still entitled to extra days (up to 100) to fully rest. Most people who complain about “medical necessity” actually win on appeal. Of course, many people do not even know they have the right to appeal, or that doing so requires little more than a letter to the hospital with some back up from the attending physician.
Seniors all over Texas are being sent home by a system that has become quick to discharge people from the hospital. “Push ’em out” made sense when a hospital stay meant at least a couple of step down levels of care. This system developed, safely, because hospital care providers could discharge a patient who was medically stabile and count on the fact that their patient was actually being moved to rehab. Now, without changing a single law, the administration has managed to deprive seniors of this important benefit by simply making it confusing to access.
If you have been told that your Medicare benefits won’t cover you for rehab because you don’t have medical necessity, insist on an appeal and stand up for the care that everyone knows is needed.