Glenda Jimmo has reached a settlement with the federal government and will finally receive Medicare coverage for claims that were denied in 2007, which led her to file a class-action lawsuit over the so-called "improvement standard."
Skilled nursing providers remain confused about Medicare changes related to the Jimmo v. Sebelius legal settlement, and many beneficiaries are not aware that their therapy might now be eligible for coverage, according to prominent long-term care expert Judith Stein. Stein is an attorney and director of the Center for Medicare Advocacy, which along with Vermont Legal Aid filed the Jimmo case.
In seeking Medicare reimbursement, skilled nursing facilities should not claim that therapy was to maintain a patient's condition if documentation reflected only an improvement goal, according to officials with the Centers for Medicare & Medicaid Services.
The Centers for Medicare & Medicaid Services has revised the Medicare Benefit Policy manual to clarify that skilled care and skilled therapy may be covered even for conditions that will not improve, per the settlement in the high-profile Jimmo v. Sebelius case.
On Jan. 24 of this year, the Jimmo vs. Sebelius class action lawsuit was settled. This was a significant win for us, the healthcare providers. As we continue to work out the details, I feel now is a good time for a reminder of the ins and outs the lawsuit. No doubt about it, it was a blockbuster decision.
The Centers for Medicare & Medicaid Services has issued a fact sheet, that clarifies the conditions the terms under which "maintenance therapy" will be covered by Medicare.
Medicare coverage of 'maintenance therapy' determined by need for skilled care, CMS clarifies in Jimmo documentApril 16, 2013
Providers must sufficiently document the need for skilled care in order to obtain Medicare coverage for so-called "maintenance therapy," the Centers for Medicare & Medicaid Services stressed in a recent fact sheet on the Jimmo v. Sebelius settlement agreement.
It's official: A federal judge approved a settlement agreement the last week of January that will allow Medicare patients to continue receiving therapy services even if they are not making measurable improvement.
The Jimmo vs. Sebelius case, filed in January 2011 in federal district court in Vermont, has now been settled. The class action lawsuit challenged Medicare's use of an "improvement standard" in determining medical necessity for skilled nursing services and outpatient therapy.