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She has a nurse check on her once a week and an aide who helps her with showers twice a week. Her hip is getting worse and transferring is very difficult for her. I worry about her falling and breaking her hip.

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Learn something new every day! Yes you are correct I was the foot soldier.
I would file an appeal then, but pay out of pocket in the interim. Thanks for the lesson!
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I think what you are describing, Shane, has been very common practice before the Jimmo vs. Sebelius court case (2014). The decision there, based on the defined purpose of Medicaid, was that the criterion for care is not whether the person is improving, but whether the care is preventing further deterioration. (This is extremely important in dementia care, where the person is never going to get better but may benefit from various cares.)

Sometimes it takes a very long time for practices to change ... for word to get out to all agencies, etc. And sometimes it is a particular case that precipitates the change. This is why I think that the OP should file an appeal. Doing so may not only help her mother, but other Medicaid recipients in her area.
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Hi Shane. You are mistaken. I assure you Medicare did pay. My mother nor my aunt had/have long term insurance unless you count me. I have in my hand Medicare Summary Notice for Part A (hospital insurance) for my aunt covering claims processed from Sept 10-December 10, 2016 under which Home Health Claims for Part A are listed on page 3 of 5. It lists care from July 20-Sept 17,2016. It has the name of the home health company, their phone number and address and the referred by dr name.
Next comes the quantity & service provided. If the service was provided. Amount the provider charged. Amount Medicare approved. Amount Medicare paid. Maximum to be billed and then notes. Note A listed the amount Medicare paid the provider. Note B tells that the amount paid was after the federal, state and local rules were applied.
There are 19 physical therapy services listed, 8 skilled nursing services listed, 26 aid/home health services and 1 surg ($6.00) dressing listed for a total of $8,046. The note A states that $4,433.37 was actually paid to the provider.
On this same summary for dates Sept 18-November 16, 2016 there were 9 skilled nursing and 17 aid/home health services for a total of $3,900. Medicare paid $1,892.57.
It has been my experience over my extended term with home health agencies (had a couple before the one working with now) that RNs, LVNs and CNA come and go and know very little about the paperwork other than their notes on their visits, which is appropriate, After all they are nurses, not bookkeepers. If I want to discuss charges, orders etc I speak with the Director of Nurses, the owner and even the dispatcher at the current agency has much more info than the nurses. No disrespect meant to you but we have had different experiences. When I started out with HHA I contacted the home health agency. I gave them the name and fax of the dr I got the order from. They sent their orders to the dr and he signs them. I have done this at least six times over the years. We have had to change primary drs a couple of times. It works very well. The nurses do blood tests. Take urine specimens. Whatever is needed. If my experience is a fluke then I guess I'm just lucky. By the way, the supplement insurance didn't pay any of this. The summary for Part B (Medical Insurance) has dr visits, blood work done at the drs office, administering a vaccine and the vaccine itself all listed and the charges and what was paid. This particular one says Medicare approved amount was $373.37, what the local coverage determination was, $190.22, of which Medicare paid $110.60 and sent the remainder of $28.23 to the supplement plan.
I've learned that states have different rules and while Medicare is federal, the states don't all pay the same.
Perhaps that is why you and I have had different experiences. I'm not an RN. I'm just the chief cook and bottle washer and I file the paperwork which tells me I am absolutely correct in what Medicare pays for my aunt. That's why I suggest that Milshy call around and/or speak to your primary.
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Are you saying she received in home care from a home health agency and now the care period is running out? Is she post op hip replacement surgery? Why was home care ordered in the first place?
Usually home care stops after a nurse, or Physical therapist determines what you said above - she has reached maximum potential for a recommended period after an acute event.
I was a home care RN and yes the home health aide stops visiting when In my judgement the patient was stable & the certification period was over (usually 60 days) and I left as well. If the skilled providers leave - the RN, PT then so does the HHA. Medicare won't continue to pay for a HHA , but you can hire an aide and self pay for the service. Medicare won't pay for continuing home care services. It is the family's responsibility ultimately to assure their loved one is taken care of after a home care episode runs out. It was rare a patient received a HHA 3x/week - we used that in cases where the patient was very debilitated and had no other support system and only for a short period of time. It wouldn't be fair to the other Medicare patients.
As for the response from 97 above, those two girls must have had long term care insurance or great supplement plans for that care to continue, because I assure you Medicare didnt pay for it. 
The Jimmy vs Sibelius case has to do with skilled care services, and a HHA is not considered "skilled care"
Should your mom still be living alone if her hip is getting worse? A HHA is there maybe 45 minutes. How does she get around when the home health staff aren't there? Does she live with you or by herself? Does she have a lifeline device to call for help? 
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I think I would call another home health agency and see what they say. I am assuming your present agency is who told you Medicare wasn't continuing to pay. I've used the same agency for years for my aunt who is 90. She has mild dementia and uses a cane. She lives alone. They started with her for wound care after a hospital stay but that only lasted a month or so ( the wound care). They do her meds, take her vitals weekly. An aid comes twice a week. They did reduce that from three times a week. They coordinate therapy which she gets several times a year. They were the same agency I used for my mother who had them about 8 years. My mother had routine blood tests and continuous therapy. If she didn't have the therapy she declined in mobility. They both had traditional Medicare with excellent supplement policies. If your mom has one of the advantage plans that might have something to do with it. A friend of mine had one of the advantage plans and she couldn't get the same care from home health. Let us know what you find out.
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As far as I know, Medicare does not usually pay for in-home care except for relatively short periods as part of a rehab effort. So rehab guidelines will apply. If your mom is not likely to be getting better (and in fact you say she is getting worse) then continued rehab is not deemed appropriate.

Obviously, continuing care is very appropriate for you mother. I don't think anyone is saying she shouldn't continue to have help. What is being said, I think, is that Medicare does not cover continuing care. But they do cover care that is needed to prevent worsening of the condition or to maintain current functionality. (Whew! This is kind of tangled logic, isn't it?)

There is a standard procedure for appealing a Medicare decision. The Medicare Summary Notice (labeled This is Not a Bill) explains the procedure and includes a form for filing an appeal. If you don't happen to have such a notice, look up Medicare Forms and you can find one online. That is the first step for you, I believe. You might want to use terms from the Jimmo vs. Sebelius case, such as stating that the care she is receiving is to prevent or slow deterioration and to help your mother maintain the maximum practicable level of function.

If this care agency has in the past provided services and the claims were denied by Medicare, you can understand they would be a little gun-shy. They don't want to continue their services if they are not going to get paid. But ultimately whether Medicare covers these services is up to Medicare. So that is where you need to appeal. I am sure the agency would be more than happy to continue billing Medicare if they are assured their bills will be considered valid.
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It sounds as if they're applying rehab guidelines as opposed to continuing care guidelines. Would it be worth giving them a call and seeing if you can sort this out?
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The home health agency thinks they are following Medicare guidelines in dismissing Mom because she is chronic and "stable in her disease state," and would not improve. Jimmo vs. Sebelius says that she can have continued care for a chronic condition.
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I'm with CM. Medicare won't dismiss your mother but they can decide not to pay for care. I am confused. More details, please?
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Sorry - who is dismissing whom?

Do you mean that Medicare has contacted the home health agency and informed them that they will no longer pay for your mother's care?

Have they formed the opinion that your mother does not need the assistance she's getting? Have you tried arguing?
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It is pretty common for Home Health Agencies to dismiss Medicare patients. I found this to help Mom. medicareadvocacy/jimmo-v-sebelius-federal-settlement-invalidated-medicare-improvement-requirement/
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I'm a bit confused - that's quite a lot of different topics you've fitted into a short paragraph! :)

Why does Medicare want to dismiss the aide, and what do they propose instead?

Is your mother's bathroom adapted for her disability? If not, can the aide wash her in bed, as though she were a bed bound patient?
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