January 2020 Download this Case Study I. Background - The Jimmo Settlement In 2013, a U.S. District Court approved the settlement agreement in Jimmo v. Sebelius,[1] requiring the Centers for Medicare & Medicaid Services (CMS) to … [Read more...] about Incorrect Implementation of the Jimmo V. Sebelius Settlement in a Skilled Nursing Facility: A Case Study
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The Jimmo v. Sebelius Settlement Agreement: An Issue Brief for Medicare Providers
January 2020 Download this Brief Table of Contents What is the Jimmo Settlement Agreement? Does Jimmo Apply to My Practice? What Does Jimmo Mean for My Patients? Are Providers Implementing Jimmo? How Do PDPM and … [Read more...] about The Jimmo v. Sebelius Settlement Agreement: An Issue Brief for Medicare Providers
Jimmo Implementation Council Meets to Discuss the State of Skilled Maintenance Care
On November 20, the Center for Medicare Advocacy, with support from the John A. Hartford Foundation, convened an online gathering of members of the Jimmo Implementation Council and other stakeholders in the effort to remove barriers to care for … [Read more...] about Jimmo Implementation Council Meets to Discuss the State of Skilled Maintenance Care
You Do Not Have to Improve! New Jimmo Resources for Appealing Medicare Denials in Nursing Homes
Medicare coverage of nursing home care depends on a resident’s need for skilled nursing and/or therapy, not the resident’s potential for improvement. However, too many nursing home residents continue to be denied skilled services on the basis of an … [Read more...] about You Do Not Have to Improve! New Jimmo Resources for Appealing Medicare Denials in Nursing Homes
Jimmo “Improvement Standard” Appeal Letter Template
[Date] [Attorney’s Name] [Address] Re: [Beneficiary’s Name], Medicare No. [XXXXX] To Whom It May Concern: I am writing on behalf of my client, [Full Name], to request an expedited reconsideration. The skilled nursing facility (SNF) … [Read more...] about Jimmo “Improvement Standard” Appeal Letter Template
Expedited/Fast-Track Medicare Appeals in Skilled Nursing Facilities in Light of the Jimmo v. Sebelius Settlement Agreement *
Background The United States District Court for the District of Vermont approved a settlement agreement in Jimmo v. Sebelius[1] on January 23, 2013. The Jimmo Settlement required the Centers for Medicare & Medicaid Services (CMS) to confirm … [Read more...] about Expedited/Fast-Track Medicare Appeals in Skilled Nursing Facilities in Light of the Jimmo v. Sebelius Settlement Agreement *
CMS Could Truly Put “Patients over Paperwork” By Fully Implementing the Jimmo Settlement
The Centers for Medicare & Medicaid Services (CMS) launched a “Patients over Paperwork” initiative in 2017 “to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary … [Read more...] about CMS Could Truly Put “Patients over Paperwork” By Fully Implementing the Jimmo Settlement
New Issue Brief: Implementing Jimmo v. Sebelius: An Overview
In 2013, a federal district court approved a settlement agreement in Jimmo v. Sebelius, No. 5:11-CV-17 (D. VT). The Jimmo Settlement confirmed that Medicare coverage should be determined based on a beneficiary’s need for skilled care (nursing or … [Read more...] about New Issue Brief: Implementing Jimmo v. Sebelius: An Overview
The National Association of Insurance Commissioners Recognizes Maintenance Therapy, Bolstering the Jimmo Settlement Agreement
The National Association of Insurance Commissioners (NAIC) is a standard-setting and regulatory support organization governed by chief insurance regulators from across the country. NAIC’s website indicates that organizational members and its … [Read more...] about The National Association of Insurance Commissioners Recognizes Maintenance Therapy, Bolstering the Jimmo Settlement Agreement
New Fact Sheet Available – Medicare Inpatient Rehabilitation Hospital/Facility Coverage In Light of Jimmo v. Sebelius
With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Fact Sheet to help Medicare beneficiaries and their families respond to unfair Medicare denials for care at inpatient rehabilitation … [Read more...] about New Fact Sheet Available – Medicare Inpatient Rehabilitation Hospital/Facility Coverage In Light of Jimmo v. Sebelius