Judge approves HHS' plan to meet Jimmo mandate

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Stein: The plan will "open doors" for people requiring long-term care
Stein: The plan will "open doors" for people requiring long-term care

The Department of Health and Human Services' plan to better explain the concept of maintenance therapy has been approved, signaling the end of a legal battle stemming from the 2013 settlement of Jimmo v. Sebelius.

The plan was accepted in a decision published Thursday by U.S. District Court Chief Judge Christina Reiss, who wrote that the plan offered up by the health agency “will cure its breach of the Settlement Agreement” and help it better educate providers and beneficiaries about what therapy coverage and the so-called Improvement Standard.

HHS' revised plan follows Reiss' August ruling stating the agency didn't hold up its end of the Jimmo bargain when it came to creating an education campaign on maintenance therapy.

The newly approved plan requires HHS to create a website on the settlement complete with information on handling claims, frequently asked questions and language stating that improvement is not a necessity for Medicare therapy coverage.

Reiss' ruling also called for two additions to HHS' proposed plan: a corrective statement about the Jimmo settlement to be published on the new webpage, and a second national provider call to clear up information from the 2013 settlement.

Judith Stein, executive director of the Center for Medicare Advocacy, said in a statement that Thursday's ruling should “open doors to critically important care” for those with long-term, chronic conditions. The Center for Medicare Advocacy was one of the groups that represented plaintiff Glenda Jimmo in the case.

“With the imprimatur of CMS on the Statement, which specifically notes that the Jimmo Settlement represents a ‘change in practice,' Medicare adjudicators and providers should have no doubt about what the correct coverage policy is,” Stein said.

Stein went on to tell NPR that while the decision in the case may not directly help beneficiaries who were already denied coverage, it could fuel their case for an appeal.

“If they think the reason they were denied was because the skilled therapy or nursing care was provided to maintain their condition or slow deterioration, then hopefully this will provide more strength for an appeal and in the future more strength for the provider to submit the claim as covered in the first case."

HHS has 14 day to file an objection to Reiss' decision, should it take issue with the two additional orders. It must implement its plan by Sept. 4.