1. PRESENTATION: RE-REVIEW OF PREVIOUSLY DENIED CLAIMS PURSUANT TO THE JIMMO SETTLEMENT In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. … [Read more...] about February 2014 – Improvement Standard Update: Re-Review of Previously Denied Claims Pursuant to Jimmo and Other Issues
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Bourgoin v. Sebelius
No. 13-cv-55-JAW (D.Me.), filed February 20, 2013 Issue: Whether the Secretary of Health and Human Services violated the Administrative Procedure Act when she approved a proposed state plan amendment to Maine's Medicaid program that will … [Read more...] about Bourgoin v. Sebelius
Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed
If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years. Please read carefully. In addition to revising Medicare manual … [Read more...] about Jimmo Class Members Can Now Have Their Coverage Denials Re-Reviewed
One-Year Anniversary of Medicare Improvement Standard Settlement Brings Victories, and Ongoing Struggle, for Beneficiaries
January 24, 2014 - Today marks the one-year anniversary of the landmark Jimmo v. Sebelius settlement. The Jimmo case was brought in 2011 by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of a nationwide class of Medicare … [Read more...] about One-Year Anniversary of Medicare Improvement Standard Settlement Brings Victories, and Ongoing Struggle, for Beneficiaries
Medicare Therapy Caps: A Call for Repeal
Medicare-covered outpatient physical, speech and occupational therapy services are subject to an annual dollar-amount payment cap. As a result, many Medicare beneficiaries have their therapy terminate prematurely when they reach the cap. … [Read more...] about Medicare Therapy Caps: A Call for Repeal
Medicare Policy Manuals Revised as Required by Jimmo Settlement
As of December 6, 2013, Centers for Medicare & Medicaid Services (CMS) Policy manuals have been updated to reflect the settlement in Jimmo vs. Sebelius, No.11-cv-17 (D.VT, January 24, 2013). The manuals now make it clear that improvement is … [Read more...] about Medicare Policy Manuals Revised as Required by Jimmo Settlement
Replacing the Broken Medicare Physician Payment Formula: At What Cost for People with Medicare?
Overview The current Medicare physician payment formula, known as the "Sustainable Growth Rate" (SGR), was designed to control the growth in aggregate Medicare expenditures for physicians' services.[1] If … [Read more...] about Replacing the Broken Medicare Physician Payment Formula: At What Cost for People with Medicare?
December 2013 – Improvement Standard Update: CMS Issues Manual Provisions Pursuant to Jimmo, and Other Issues
1. PRESENTATION: CMS MANUAL PROVISIONS ISSUED PURSUANT TO THE JIMMO SETTLEMENT The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement. … [Read more...] about December 2013 – Improvement Standard Update: CMS Issues Manual Provisions Pursuant to Jimmo, and Other Issues
Improvement Standard Update: Re-Review Request Form Now Available
The Jimmo Settlement Agreement provides for the re-review of certain Medicare claims under clarified maintenance coverage standards for the SNF, HH, and OPT benefits, applicable when a patient has no restoration or improvement potential, but … [Read more...] about Improvement Standard Update: Re-Review Request Form Now Available
Examining Inappropriate Use of Antipsychotic Drugs, Part Two: How Surveyors Describe How, When, and Why They Cite Antipsychotic Drug Deficiencies (Note: Nearly 200 pages)
Examining Inappropriate Use of Antipsychotic Drugs, a Report in three Parts, looks at antipsychotic drug use in skilled nursing facilities (SNFs) and nursing facilities (NFs) from two perspectives. First, it analyzes the antipsychotic drug … [Read more...] about Examining Inappropriate Use of Antipsychotic Drugs, Part Two: How Surveyors Describe How, When, and Why They Cite Antipsychotic Drug Deficiencies (Note: Nearly 200 pages)