Custodial care is the care you get when you need help with activities of daily living (ADL) such as bathing, dressing etc. The non-medically trained help you get to do these things are not helping you make progress to a state of not ever needing care again. Medicare doesn’t pay for custodial care. It says so on their website, Medicare.gov. In fact, you can still read those words on this website and probably hundreds if not thousands of others. Medicare denies coverage to patients whose conditions are unlikely to improve. But that’s all likely to change on or about Jan. 24, 2013. That’s when a judge is likely to approve a settlement between the federal government and consumer advocates that will no longer allow Medicare to deny coverage on the basis of whether or not you will improve. The ruling is expected to help tens of thousands of Medicare recipients who have previously been turned down.
So what are the new rules? To receive coverage for home health care, the recipient needs to be homebound and their doctor must approve a plan of care every 60 days that includes a nurse, physical or speech therapist. The individuals hired must work for a home health agency certified by Medicare.
An article detailing the specifics of the ruling including how to appeal a denial that was made on or after Jan. 18, 2011 is here.
