The Issue Brief linked below is posted and reprinted with permission of the author, Catherine G. Hopper, Esq.
The Center for Medicare Advocacy is grateful to Ms. Hopper not only for permission to reprint, but for her diligence in understanding and sharing the myth of the need to improve in order to receive Medicare coverage for necessary care.
The “Improvement Standard,” litigated by the Center for Medicare Advocacy in Jimmo v. Sebelius, remains one of our top priorities for the new administration. For details, see the Center’s recent Transition Memorandum for Biden Administration Department of Health & Human Services (HHS)
Ms. Hopper summarizes the issue elegantly in the introduction to her brief, stating
The Medicare rules themselves never prevented Medicare recipients from receiving coverage for necessary nursing or therapy services when they ceased to improve, but the need for an “improvement standard” became an ingrained myth among the morass of companies who are responsible for reviewing Medicare claims.