My father(78) had a severe hemmoraghic stroke a few weeks ago(right dominant side paralyzed, loss of language, etc). He is in a wonderful inpatient rehabilitation facility and making better than expected progress. At the first care partner meeting, the facility case manager said that they requested 28 days of rehab, but Medicare only approved 23. We obviously want my father to stay here are long as possible to regain as much function as he can. My question is:
Do I need POA(Power of attorney) when it comes time to appeal the medicare decision?
If I do need POA, how can I get it? He can comprehend quite a bit but can really only communicate with head nods or shakes at this point.
Time is of the essence on being able to deal with this. There are 2 tracks: 1. Appeals from a SNF and 2. Appeals from a CORF.
He should get an official Notice within 24/48 hrs of his rehab ending and the appeal, I’m pretty sure, has to be filed waiting that period. The exact timeframe will be in the Notice.
Technically with nobody being POA, it’s on him to file the appeal as right now you have no legal standing to do this. But you can certainly help him do this (nudge nudge, wink wink, just sayin’). Maybe he could sign a POA form, again just sayin’. No POA is going to mean a constant butt rash for you and other family to do things for him.
Those 23 days was based on the discharge notes he exited the hospital with. In his discharge paperwork there will be ICD-10 codes and each one has a specific timeframe based on what most individuals do to be “progressing” in their rehab. If need be it can be extended if there are medical conditions that can factor in to get an increase in days. The rehab staff at the NH is beyond mucho important in all this as their daily notes placed into his chart are what Medicare will look at to determine if more time needed and if an appeal will be successful.
Medicare for appeals process is divvied up into regions and the decisions are done by MACS aka Medicare Adminstrative Contractors. The staff at the MACS are very knowledgeable and experienced as how to get things done and quickly. But they are dependent on info in his health chart to support a decision to extend his care covered by Medicare.
Things can and do fall through the cracks in health charts. Sometimes it’s something not included from his hospital exit, sometimes something doesn’t get inputted over a weekend. Prescriptions get overlooked. His chart has to HAS TO show he is still very much at need for rehab.
Good luck in your quest. & also try to get Dad to do an online SSA account and within it have him do a proactive request for you to be his representative payee should he need to have that in place later on. There’s a SSA form for this that he has to complete. SSA does not recognize POA so it’s very important that he has a future rep payee named.
An attorney can attend your father in while in care.
He will assess your father's ability to give you POA, but this may be crucial in future. These are uncertain times. I had my brother's attorney in hospital and rehab to do our POA and Trustee papers; so glad I did.
On to the other question.
While in rehab now call in the social worker there.
He/she will help you with the appeal forms.
Wishing all of you the very best of luck as you negotiate all of this.
With his good progress you have a very real chance at getting more time.
Your father can "make his mark" witnessed by notary or witnesses if necessary while you fill out the appeal forms.
I know that when my late husband had a massive stroke back in 1996, which affected his right side and he needed A LOT of PT, OT and speech therapy, that our insurance at the time only allowed so much therapy at the rehab center, but did continue covering out-patient therapy at the same facility for quite some time afterward.
Now my husband wasn't on Medicare yet as he was only 48 when he had his stroke, but I'd like to think that any and all insurance would pay for any needed therapy needed as long as the patient continues to improve.
So instead of panicking that your father may be released soon from rehab, I would be asking what the next steps are regarding his therapies either at home or at a facility, so he can continue to improve.
I wish your father well in continuing to improve.
Since it is open enrollment, it will be easy to find the plan coverage even if it is for 2025.
Keep working with the rehab social worker. If he is not ready to be on his own and someone cannot be with him then it is an unsafe discharge.