MEDICARE: Denying Home Care To Elderly

      "Frail, elderly Medicare beneficiaries with severe illnesses are being improperly denied coverage for home health services that they are entitled to receive, U.S. judges have ruled in thousands of recent cases around the country," the New York Times News Service/Baltimore Sun reports. In an attempt to control the rising costs of home care services, the Clinton administration has argued that patients who are in stable condition and are not homebound do not qualify for Medicare-reimbursed home care services. However, "judges have rejected the Clinton administration's arguments in case after case involving patients who are chronically ill, disabled, blind or confined to wheelchairs, or are suffering from such ailments as Alzheimer's disease, Parkinson's disease and multiple sclerosis."

Keeping Score
      "Thirty-nine percent of the people who contested the denial of" home care reimbursement "won coverage at the first level of review. Of those who pressed their claims, 81% prevailed on appeal," the New York Times News Service/Baltimore Sun reports. Judith Stein, director of the Center for Medicare Advocacy, said, "These decisions should be a signal to the agency that it has a problem." However, "Medicare officials deny that there is a pervasive problem." The disagreement illustrates "how the government, under pressure to crack down on fraud and abuse in Medicare, sometimes denies care that doctors and patients see as medically necessary." Health Care Financing Administration Administrator Nancy-Ann Min DeParle said that the "challenge ... is to distinguish people who truly need home health care from those who are using Medicare to pay for 'chore services.'" Medicare officials are "reviewing the eligibility criteria for home care, including the definition of 'homebound,'" and will make recommendations to Congress later in the year. They are likely to "call for tightening the current standards" (Pear, 2/15).