(CMS.gov, Sept 10, 2024. Last visited 2/28/2025.)
Q1: What is the Jimmo Settlement Agreement (January 2013)?
A1: The Jimmo Settlement Agreement clarified that when a beneficiary needs skilled nursing or therapy services under Medicare’s skilled nursing facility (SNF), home health (HH), and outpatient therapy (OPT) benefits in order to maintain the patient’s current condition or to prevent or slow decline or deterioration (provided all other coverage criteria are met), the Medicare program covers such services and coverage cannot be denied based on the absence of potential for improvement or restoration.
Q15: Does the Jimmo Settlement Agreement apply to beneficiaries in Medicare Advantage plans?
A15: Yes. Medicare Advantage plans must cover the same Part A and Part B benefits as original Medicare, and must also apply the standards for coverage of skilled care as clarified by the Jimmo Settlement Agreement.