She is currently in the rehab section in the same facility and they say she must stay there until her 100 days are up and then private pay. There is no other reason for her to have skilled care except for PT which she can continue on an in-home basis or out-patient going down the hall to the same PT room.
Current Medicare Coverage Policies
Private insurers and major Medicare Advantage health plans (Medicare Part C) currently recognize that home infusion therapy is a
cost-effective, clinically effective treatment option and provide comprehensive coverage of this therapy. In contrast, the Medicare
fee-for-service program is the only major health program in the country that does not provide meaningful coverage of infusion therapy
in a patient’s home. Rather, Medicare Parts A, B and D provide inadequate, piecemeal coverage of elements of infusion therapy administered
in a patient’s home.
Most infusion drugs are covered by Medicare Part D. Medicare Part D reimburses providers for the drugs and a retail-based dispensing
fee, which falls short of covering the costs associated with the safe provision of home infusion drugs. Importantly, Medicare
Part D does not cover the specialized infusion-related services, equipment and supplies, and it is for this reason that most Medicare
beneficiaries do not have access to infusion drugs in the home, despite that the drugs are in fact covered in that setting.
Medicare Part B provides coverage under the durable medical equipment benefit for a limited number of drugs that are administered
using a mechanical or electronic external infusion pump. Unfortunately, only a few drugs are covered under this benefit, such as some
anti-viral drugs, chemotherapy drugs, inotropic therapies, pain management drugs, and immune globulin administered subcutaneously.
The home nursing visits for the small number of beneficiaries receiving home infusion therapy may be covered by the Medicare Part
A home health benefit if the beneficiary meets the applicable criteria, i.e., is homebound and is in need of intermittent home nursing
services. Some Medicare fee-for-service beneficiaries who do not qualify for the Medicare home health benefit may have other insurance
that covers some of the costs of home infusion that are not reimbursed by Medicare.