Deadline for CMS to Make Changes to Medicare Policy Manual on Improvement Standard Approaches
Tuesday, October 8, 2013
by: Policy Team

Section: Public Policy and Advocacy




The Centers for Medicare and Medicaid Services (CMS) will soon release a revised Medicare Policy Manual, the exact date contingent on the length of the current government shutdown. This manual explicitly outlines that a lack of improvement cannot cause a denial of coverage for beneficiaries.  CMS has until mid-January to release the changes and conduct an education campaign required by the settlement that ended the "improvement standard.”

In January, CMS officials said the manual revisions would take about six months, followed by a six-month education campaign.  Under the terms of a settlement in a legal suit won by the Center for Medicare Advocacy, CMS is required to revise the Medicare manual, as well as other policies and guidance, to ensure that Medicare coverage includes skilled maintenance services in home health, nursing home and outpatient settings as long as all other qualifying criteria are met. After the policy is released, CMS must conduct an education campaign.

The settlement will affect beneficiaries with claims dating back to 2011 and will allow those claims to be reevaluated.    
For a CMS fact sheet on the Jimmo v. Sebelius Settlement Agreement: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf
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