Jimmo v. Sebelius: The so-called Medicare "Improvement Standard" Deemed Illegal, Skilled Maintenance Care Now Covered
A nationwide class of Medicare beneficiaries and seven organizations reached a settlement with the Department of Health and Human Services (HHS) and Department of Justice (DOJ) in the case of Jimmo v. Sebelius. The settlement stipulates that skilled services to maintain an individual’s condition or prevent or slow their decline are covered by Medicare and that the so-called “improvement standard” that Medicare had been employing is illegal.
Under the text of the settlement agreement, Medicare coverage hinges on whether the skilled services of a health care professional are medically necessary, not whether the beneficiary will “Improve.” Medicare can no longer deny care to patients on the grounds that their condition is stable, chronic, or not improving. The Centers for Medicare & Medicaid Services (CMS) must now make revisions to the Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatient settings. CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve.
(Source: aota.org)
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