‘Jimmo’ Plaintiffs Return to Court to Urge Enforcement Despite a three-year-old ruling to the contrary, Medicare continues to deny coverage of skilled rehabilitation services if the Medicare beneficiary does not show improvement from the treatment. This denial prevents patients with degenerative conditions from receiving treatment that could help them maintain or slow the worsening of function and contradicts ... News in Brief
Free
News in Brief  |   May 01, 2016
‘Jimmo’ Plaintiffs Return to Court to Urge Enforcement
Author Notes
Article Information
Special Populations / Practice Management / Regulatory, Legislative & Advocacy / News in Brief
News in Brief   |   May 01, 2016
‘Jimmo’ Plaintiffs Return to Court to Urge Enforcement
The ASHA Leader, May 2016, Vol. 21, 10. doi:10.1044/leader.NIB6.21052016.10
The ASHA Leader, May 2016, Vol. 21, 10. doi:10.1044/leader.NIB6.21052016.10
Despite a three-year-old ruling to the contrary, Medicare continues to deny coverage of skilled rehabilitation services if the Medicare beneficiary does not show improvement from the treatment. This denial prevents patients with degenerative conditions from receiving treatment that could help them maintain or slow the worsening of function and contradicts Medicare law, according to the Center for Medicare Advocacy.
In a Motion for Resolution of Non-Compliance, the Center for Medicare Advocacy and Vermont Legal Aid—the plaintiffs in the 2013 Jimmo v. Sebelius case—have returned to court to ask for enforcement of the decision. In Jimmo, the court determined that Medicare may not deny speech-language treatment, occupational therapy or physical therapy simply because the beneficiary shows no functional progress. The settlement specifically covers outpatient, inpatient and home health services, as well as those provided by Medicare Advantage Plans.
The settlement also requires the Centers for Medicare and Medicaid Services to eliminate the “Medicare improvement standard” from its policy manuals and to educate Medicare contractors about the change. The plaintiffs allege this education has been inadequate.
The long-practiced “improvement standard” contradicts Medicare law, and the settlement explicitly underscores that Medicare is available for skilled nursing and therapy to maintain an individual’s condition or slow deterioration, according to the Center for Medicare Advocacy.
For people with degenerative and progressive diseases—such as multiple sclerosis, Parkinson’s disease and amyotrophic lateral sclerosis (ALS)—skilled services can prevent deterioration and maintain functional levels.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
May 2016
Volume 21, Issue 5