CMS Posts Fact Sheet on Jimmo v. Sebelius Settlement
Monday, April 8, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy




 On April 4, the Centers for Medicare and Medicaid Services (CMS) contacted VNAA to announce that fact sheet on the Jimmo v. Sebelius Settlement. Below is an excerpt from the fact sheet.
 
“In the case of Jimmo v. Sebelius, the Center for Medicare Advocacy (CMA) alleged that Medicare claims involving skilled care were being inappropriately denied by contractors based on a rule-of-thumb “Improvement Standard”—under which a claim would be summarily denied due to a beneficiary’s lack of restoration potential, even though the beneficiary did in fact require a covered level of skilled care in order to prevent or slow further deterioration in his or her clinical condition. In the Jimmo lawsuit, CMS denied establishing an improper rule-of-thumb ‘Improvement Standard.’…
 
The settlement agreement is intended to clarify that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration. As such, any actions undertaken in connection with this settlement do not represent an expansion of coverage, but rather, serve to clarify existing policy so that Medicare claims will be adjudicated consistently and appropriately…
 
The Jimmo v. Sebelius settlement agreement specifies that Nothing in this Settlement Agreement modifies, contracts, or expands the existing eligibility requirements for receiving Medicare coverage.’”
 
To access and review this factsheet please visit the Home Health Agency Center Web page of the CMS Website in the “Spotlight” section by clicking here.
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