In re L.R.

(SSA Office of Hearings & App. Feb. 21, 1996) ; Clearinghouse Number: 51591

Description

Beneficiary Entitled to Medicare Home Health Coverage for Daily Skilled Nursing Care Despite His Indefinite Need for Such Care

Abstract

The administrative law judge (ALJ) has held that claimant is entitled to Medicare coverage for daily nursing care indefinitely, so long as that care is provided on a part-time basis. After suffering a pulmonary embolism, claimant began to receive daily nursing services at home. The fiscal intermediary denied Medicare coverage for claimant’s home health care. The fiscal intermediary asserted that beneficiaries who require skilled nursing care for more than four days per week for an indefinite period are not entitled to Medicare home care benefits. Claimant appealed. The ALJ held that Medicare law provides for home health care coverage for beneficiaries requiring daily part-time nursing services, even if there is no predictable end date for the need for such services. Finding that skilled nursing care should be covered in the home care setting so long as the care is being provided on a less than full-time or 24-hour-per-day basis, the ALJ held that claimant is entitled to Medicare coverage for his daily nursing care.

Additional Information

Docket Date
1996-02-21 00:00:00+00:00