Marking another step toward guaranteeing Medicare coverage for nursing home residents needing skilled services, a federal judge on Thursday approved the October 2012 settlement agreement in Jimmo v. Sebelius.
The high-profile case involved a woman denied Medicare coverage for treatment of her chronic, diabetes-related conditions. As a result of the settlement with the Department of Health and Human Services, individuals who need maintenance care for conditions that are not improving can no longer be denied Medicare coverage under an Improvement Standard.
The Centers for Medicare & Medicaid Services will have to update its policy manual and undertake an education campaign to increase awareness of the policy, according to the settlement agreement.
As per the settlement, Medicare coverage is immediately available to many beneficiaries needing maintenance care, the Center for Medicare Advocacy stressed.
HHS spokeswoman Erin Shields Britt said in October that the agency did not want to officially comment until the settlement was finalized, according to The New York Times. However, Britt said the settlement would clarify Medicare policy “so that claims from providers will be reimbursed consistently and appropriately, which is always our aim.”