- Medicare coverage turns on whether skilled care is required, not improvement
(This is key to Jimmo) - Restoration potential is not the deciding factor
- Medicare should not be denied because the beneficiary has a chronic condition or needs services to maintain his/her condition
- An “Individualized Assessment” of each claim is required
- Rules of thumb should not be used
Per CMS: “This is long-standing criteria, consistent with regulations”
See cms.gov/medicare/settlements/jimmo