The Centers for Medicare and Medicaid Services (CMS) has created a web page devoted to the settlement in Jimmo v. Sebelius. The page is one of the court-ordered corrective actions required to comply with the a 2013 settlement that was supposed to end Medicare's "improvement standard."
In addition to a prominent message reminding the Medicare community that nursing and therapy services can be used to maintain function or slow decline, the page links to a list of frequently asked questions about the Jimmo Settlement Agreement and gathers in a single location various public documents related to the agreement.
For decades, home health agencies and nursing homes that contract with Medicare routinely terminated the Medicare coverage of a beneficiary who had stopped improving, even though nothing in the Medicare statute or its regulations required improvement for continued skilled care. In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a class action lawsuit, against CMS in federal court, aimed at ending the government’s use of the improvement standard. CMS agreed to settle the lawsuit and to revise the relevant portions of the Medicare manual to reflect that a patient does not need to be improving in order to continue receiving skilled care, as well as to conduct a nationwide education campaign.
But three years after the settlement, the Center for Medicare Advocacy was still getting reports that Medicare was denying coverage to patients who were not improving. Earlier this year, it filed a motion in federal court for resolution of non-compliance, asking the court to order the federal government to carry out additional educational activities. The U.S. District Court for the District of Vermont approved the federal government's plan for corrective action that involved creating a website devoted to Jimmo, issuing additional statements, and holding additional trainings. The court ordered the federal government to complete the corrective action by September 4, 2017.
“People living with MS, Parkinson’s Alzheimer’s, paralysis and other long-term conditions have waited long enough for this relief," said Judith A. Stein, Executive Director of the Center for Medicare Advocacy, in a news release following CMS's latest action. "We hope that the new CMS education and information, which can be found at CMS.gov and printed out with the CMS logo, will help convince providers that Medicare really is available for people who need this critical maintenance care.”
To visit the new web page, click here.
Subscribe to the Knowledge Bank.
