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1/Today, I learned that no meaningful process exists for people to apply for critical benefits from a new Medicare program, created to extend coverage to thousands of vulnerable, elderly patients in nursing homes impacted by COVID-19--including my mom.
2/Ordinarily Medicare gives patients 100 days of skilled nursing care, and they are usually not eligible for more benefits unless they break their "spell of illness" for 60 days. But COVID outbreaks in homes have limited access to doctor's, surgeries, and releases to do that.
3/So, on March 13, 2020, Medicare said it would suspend that policy for beneficiaries who have been “delayed or prevented by the [COVID-19] emergency” from renewing their benefits. The waiver gives applicants up to another 100 days of critical coverage. https://www.cms.gov/files/document/coronavirus-snf-1812f-waiver.pdf
![3/So, on March 13, 2020, Medicare said it would suspend that policy for beneficiaries who have been “delayed or prevented by the [COVID-19] emergency” from renewing their benefits. The waiver gives applicants up to another 100 days of critical coverage. https://www.cms.gov/files/document/coronavirus-snf-1812f-waiver.pdf](https://pbs.twimg.com/media/EZEKDgSUMAAKYfQ.jpg "3/So, on March 13, 2020, Medicare said it would suspend that policy for beneficiaries who have been “delayed or prevented by the [COVID-19] emergency” from renewing their benefits. The waiver gives applicants up to another 100 days of critical coverage. https://www.cms.gov/files/document/coronavirus-snf-1812f-waiver.pdf")
![3/So, on March 13, 2020, Medicare said it would suspend that policy for beneficiaries who have been “delayed or prevented by the [COVID-19] emergency” from renewing their benefits. The waiver gives applicants up to another 100 days of critical coverage. https://www.cms.gov/files/document/coronavirus-snf-1812f-waiver.pdf](https://pbs.twimg.com/media/EZEKN8TU4AAdLLO.png "3/So, on March 13, 2020, Medicare said it would suspend that policy for beneficiaries who have been “delayed or prevented by the [COVID-19] emergency” from renewing their benefits. The waiver gives applicants up to another 100 days of critical coverage. https://www.cms.gov/files/document/coronavirus-snf-1812f-waiver.pdf")
4/To give you an example of why an extension is so important, consider my mom. Following a coma that required intubation and ventilation in January, she was on the road to recovery. Doctors gave her a temporary tracheostomy saying it could be reversed with rehab.
5/However, COVID quickly obstructed her access to critical medical care and rehab to recover and be released safely. First, specialists found she needed corrective surgery on her vocal chords, in addition to therapy, to expand her airway, reverse her tracheostomy and recover.
6/But she was repeatedly prevented from going to doctors offices and scheduling her surgery, as medical offices canceled appointments with patients like her in March, citing COVID risk, and hospitals shut down surgeries like hers, again because of COVID. https://abc7.com/health/socal-doctor-explains-why-its-critical-hospitals-reopen-for-screenings-surgeries/6153579/
7/Worse, mom's home experienced an outbreak. According to the LA Department of Health, 38 residents and 29 staff tested positive for COVID at her home. Eight people died. Mom remains isolated in her room and receives only limited physical therapy in bed. http://publichealth.lacounty.gov/media/coronavirus/locations.htm
8/The therapy she continues to receive remains vital—it has hopefully prevented her from becoming weaker—but the COVID-19 emergency continues to prevent her from completing the therapy she would ordinarily had received had the outbreak not occurred.
9/Moreover, because of the outbreak at her home and her compromised respiratory system, no other place could take mom. The facility only completed testing all residents and staff last week. Other homes without outbreaks would not take untested residents from homes like mom's.
10/So, as mom approached her 100 day limit, isolated in a home with an outbreak, I called to ask how to apply for this extension. The home didn't have an answer, but suggested I file an appeal with Livanta, an independent contractor that hears Medicare appeals.
11/I did. But Livanta said they had never heard of this and there was no way to introduce evidence to support mom's claims for an extension. Livanta, which hears claims from 27 states, only typically determines whether someone needs more care. They said to call Medicare directly.
12/I pointed out, however, that under Medicare's regulations, I still needed Livanta to determine that she needed more care. So, they were suggesting I had to simultaneously make my appeal on two separate tracks. They said: "That could be right."
13/So, I called Medicare. Medicare's representatives said they could not provide any information about the extension and that I would have to rely on mom's nursing home to file the claim. They said a hotline existed for nursing homes making such claims. It was "out of my hands."
14/I protested that this was *our* claim and that it is the patient who is responsible for $100,000s if the claim is denied. And a home has a conflict of interest because evidence we needed to show COVID "prevented" her from recovering involved an outbreak at mom's very home.
15/Nevertheless, she said this was in the skilled nursing facility's hands--the same facility that originally suggested that I file my own appeal with Medicare.
16/Final notes: I've consulted with the Center for Medicare Advocacy and other public health law experts about what this very important provision means for the many patients in skilled nursing homes affected by COVID.
17/And I'm no slouch either. I teach administrative law. I've published studies on the Medicare adjudication system in prestigious law journals. Even with all my privileges, I have no clue how to apply for these critical benefits to help my mom. https://www.yalelawjournal.org/article/inside-the-agency-class-action
18/So, @SeemaCMS @CMSGov, if you have answers, please help us. Thousands of nursing home residents, like my mom, have been displaced by COVID-19. They're the most vulnerable of the vulnerable. And without guidance, her life and savings are on the line. cc: @BradSherman
