Corrective statement in Jimmo case gets greenlight from all involved parties

A federal court has approved the corrective statement that the Centers for Medicare & Medicaid Services will use as part of its settlement in the Jimmo v. Sebelius case, advocates involved in the proceedings announced last week.

The statement, which clarifies Medicare coverage for skilled maintenance therapy, was required as part of a plan approved by the court earlier this month. The statement explains that a therapy program “to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.”

The approved statement also rejected the “Improvement Standard” by noting the Jimmo settlement “may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve.”

Attorneys with the Center for Medicare Advocacy said in a statement released Thursday that they were pleased with the statement's emphasis on maintenance coverage availability.

“The CMS Corrective Statement is intended to make it absolutely clear that Medicare coverage can be available for skilled therapy and nursing that is needed to maintain an individual's condition or slow deterioration,” said Judith Stein, executive director for the CMA and counsel for the plaintiffs in the case. “We are hopeful this will truly advance access to Medicare and necessary care for people with long-term and debilitating conditions.”