- 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
- §n “Individualized Assessment” of each claim is required
- Rules of thumb should not be used
Per CMS: “This is long-standing criteria, consistent with regulations”
Questions to Ask:
- Is a skilled professional needed to ensure nursing or therapy is safe and effective? Yes → Medicare coverable.
- Is a qualified nurse or therapist needed to provide or supervise the care? Yes → Medicare coverable.
Regardless of whether the skilled care is needed to improve, or maintain, or slow deterioration of the condition. Or if condition is “chronic” or “stable” or has “plateaued.”
Help Open Doors to Necessary Care!
Search for Jimmo and Important Message about Jimmo at CMS.gov