The National Multiple Sclerosis Society, Parkinson’s Action Network, Paralyzed Veterans of America and National Committee to Preserve Social Security and Medicare were among the groups that filed a class-action lawsuit against CMS, arguing the agency’s coverage policy unfairly restricted coverage to patients with chronic conditions and disabilities.
In order to qualify for CMS-funded skilled nursing, long-term care or home healthcare services, patients were required to demonstrate a likelihood of improvement. Given the nature of the federal payment policy, patients with certain chronic conditions and disabilities — such as Alzheimer’s disease and spinal cord injuries — struggled to pay for their healthcare.
Now, CMS has agreed to tweak its official coverage policy so it is no longer the patients’ onus to prove likelihood of improvement. Rather, the policy will reflect that CMS will pay for services needed to “maintain the patient’s current condition or prevent or slow further deterioration,” even if the patient’s state of health is not likely to improve, according to the report.
Federal District Court Judge Christina Reiss is expected to approve the settlement.
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