Patients with mesothelioma and other chronic diseases and conditions may have improved care, as part of a proposed change of Medicare policy. Under a proposed legal settlement of a landmark class-action lawsuit, Medicare would start covering the costs of certain treatments for those patients with long-term diseases who need skilled services simply to maintain or slow their deterioration regardless of the underlying illness.
For years, thousands of mesothelioma patients and other Medicare beneficiaries with incurable diseases have been denied needed care based on the grounds that their condition was “not improving.” Medicare advocates said the “improvement” standard seemed to lead to cutting off physical, occupational and speech therapy for patients who had reached a plateau in their treatment.
The application of the standard is particularly devastating for patients with advanced cancers, ALS, Parkinson’s disease, Multiple Sclerosis and other degenerative diseases who are not going to improve and are seeking simply to hold onto their health and slow the effects of a disease.
According to an article in The New York Times, the proposed settlement, once approved by a federal district judge, will lead the Centers for Medicare and Medicaid Service to rewrite the Medicare benefits manual to delete suggestions that a patient’s receipt of Medicare coverage depends on the patient continuing to show improvement. The new policy would state that Medicare will cover skilled nursing care and therapy services needed for a patient to maintain their health.
Medicare provides up to 100 days of coverage per benefit period. The settlement confirms that Medicare is available for skilled nursing and therapy that is needed to maintain a person’s condition or prevent slow deterioration, for nursing home, home health and outpatient therapy.
According to the Center for Medicare Advocacy, a party to the lawsuit, the settlement is NOT limited to particular conditions or diseases. It applies to anyone who requires skilled services, regardless of the underlying illness, disability or injury.
The lawsuit was brought on behalf of a nationwide class of Medicare beneficiaries by six individuals and seven national organizations representing people with chronic conditions.
Mesothelioma, a cancer caused by exposure to asbestos, strikes 2,500 to 3,000 people a year in the United States. Symptoms of mesothelioma take 20 years to 50 years to appear. As a result, people diagnosed with mesothelioma are typically older workers, retired workers and veterans who were exposed to asbestos dust in a workplace or during military service. While the disease takes decades to appear, it advances rapidly once it is diagnosed.