Coverage does not turn on the presence or absence of potential for improvement but rather on the need for skilled care. Services can be skilled and covered when:CMS revised Medicare policy manuals, guidelines, instructions to reflect these … [Read more...] about Know Jimmo | It’s about the Care
Archives for January 2024
Know Jimmo | No Improvement Needed
The Jimmo Settlement, approved by the federal district court in 2013, confirmed Medicare coverage should be determined by a beneficiary’s need for skilled care, not the individual’s potential for improvement; and that Medicare covers skilled care to … [Read more...] about Know Jimmo | No Improvement Needed
New Medicare Drug Provisions Now in Effect – Including Out-of-Pocket Changes
The Inflation Reduction Act of 2022 (IRA), signed into law by President Biden on August 16, 2022, has already provided cost-savings for Medicare beneficiaries through provisions that took effect last year in 2023, including a monthly cap of $35 for … [Read more...] about New Medicare Drug Provisions Now in Effect – Including Out-of-Pocket Changes
Reminder: Limited Opportunity to Make Certain Medicare Plan Changes Through March 31st
People who began 2024 enrolled in a Medicare Advantage (MA) plan have an additional opportunity to switch MA plans or disenroll from an MA plan and enroll in traditional Medicare with a Part D prescription drug plan during the first 3 months of the … [Read more...] about Reminder: Limited Opportunity to Make Certain Medicare Plan Changes Through March 31st
Statement on Proposed Appeal Rules for Hospital Observation Status
As a result of the Center for Medicare Advocacy’s successful litigation, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule on December 21, 2023, to implement appeals processes for hospital patients whose status is changed … [Read more...] about Statement on Proposed Appeal Rules for Hospital Observation Status
A Poster Child for Meaningful, Corporate-Wide Enforcement of Nursing Facilities
Late on the afternoon of December 15, 2023, Northview Village Nursing Home, the largest nursing facility in St. Louis, Missouri, abruptly closed, moving all 170 remaining residents overnight to 14 other nursing facilities in Missouri and Illinois … [Read more...] about A Poster Child for Meaningful, Corporate-Wide Enforcement of Nursing Facilities