‘Jimmo’ Website Debunks Medicare Improvement Standard Medicare covers skilled therapy services that a patient needs to maintain function or to prevent or slow decline, emphasizes a new Centers for Medicare and Medicaid Services (CMS) website. Publicizing this “maintenance coverage standard” is required as part of the 2013 settlement agreement in the Jimmo v. Sebelius case, which ... News in Brief
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News in Brief  |   December 01, 2017
‘Jimmo’ Website Debunks Medicare Improvement Standard
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Practice Management / News in Brief
News in Brief   |   December 01, 2017
‘Jimmo’ Website Debunks Medicare Improvement Standard
The ASHA Leader, December 2017, Vol. 22, 15. doi:10.1044/leader.NIB3.22122017.15
The ASHA Leader, December 2017, Vol. 22, 15. doi:10.1044/leader.NIB3.22122017.15
Medicare covers skilled therapy services that a patient needs to maintain function or to prevent or slow decline, emphasizes a new Centers for Medicare and Medicaid Services (CMS) website.
Publicizing this “maintenance coverage standard” is required as part of the 2013 settlement agreement in the Jimmo v. Sebelius case, which established that Medicare could not deny coverage of therapy services simply because the patient shows no functional progress. The suit alleged that many Medicare providers and contractors denied coverage to patients who failed to progress, holding them to a nonexistent “improvement standard.”
A federal judge ordered enforcement of the agreement three years later, after the original plaintiffs returned to court because CMS failed to comply with the provisions, which included eliminating the improvement standard from policy manuals and educating Medicare contractors about the change.
According to the website, coverage of skilled nursing and skilled therapy services in skilled nursing facilities, home health and outpatient centers “does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.”
The site includes links to documents related to the Jimmo case and settlement agreements, relevant chapters in the Medicare benefit policy manual, manual updates, Medicare Learning Network articles, frequently asked questions and other resources.
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December 2017
Volume 22, Issue 12