CMS Must Improve ‘Jimmo’ Compliance and Education Medicare must step up its efforts to educate its contractors that they may not deny speech-language treatment (and physical and occupational therapy) simply because the beneficiary shows no functional progress, according to a federal judge’s order. The order requires the Centers for Medicare and Medicare Services (CMS) to comply with ... News in Brief
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News in Brief  |   October 01, 2016
CMS Must Improve ‘Jimmo’ Compliance and Education
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Special Populations / Genetic & Congenital Disorders / Regulatory, Legislative & Advocacy / News in Brief
News in Brief   |   October 01, 2016
CMS Must Improve ‘Jimmo’ Compliance and Education
The ASHA Leader, October 2016, Vol. 21, 11. doi:10.1044/leader.NIB6.21102016.11
The ASHA Leader, October 2016, Vol. 21, 11. doi:10.1044/leader.NIB6.21102016.11
Medicare must step up its efforts to educate its contractors that they may not deny speech-language treatment (and physical and occupational therapy) simply because the beneficiary shows no functional progress, according to a federal judge’s order.
The order requires the Centers for Medicare and Medicare Services (CMS) to comply with a January 2013 settlement agreement in the Jimmo v. Burwell case. The settlement ended the illegal practice of denying coverage to Medicare beneficiaries who failed to improve as the result of their treatment. Medicare long defined “reasonable and necessary”—a criterion for coverage—to include the expectation that the patient’s condition would improve significantly in a reasonable period of time.
Patients with degenerative conditions, however, require treatment to maintain their functional levels and prevent functional declines. The settlement explicitly underscores that Medicare must cover skilled nursing and therapy to maintain function or slow deterioration, allowing patients with degenerative conditions to receive treatment with no expectations of improvement.
The original plaintiffs in the suit returned to court earlier this year to ask for enforcement of the decision. They claimed that Medicare had not implemented the provisions of the settlement, which requires CMS to eliminate the “improvement standard” from its policy manuals and educate Medicare contractors about the change.
The plaintiffs filed a Motion for Resolution of Non-Compliance, saying that CMS had failed to communicate the necessary information to the providers and contractors that make Medicare coverage decisions.
The court indicated that at least some of the information provided in the education campaign was inaccurate and failed to reflect the maintenance coverage standard. CMS must develop corrective action for the inadequate education effort.
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October 2016
Volume 21, Issue 10