Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Checklist for Medicare Nursing Home “Improvement Standard” Denials

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With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for skilled nursing facility care based on an erroneous “Improvement Standard.” The Checklist outlines the coverage criteria for SNF care and emphasizes language from the Jimmo Settlement Agreement.  Per the Settlement, the Centers for Medicare & Medicaid Services (CMS) revised the Medicare Benefit Policy Manual to clearly disavow any notion that individuals receiving care in a SNF must improve in order for their care to be covered by Medicare.

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