"Medicare has never supported the imposition of an “Improvement Standard” rule-of-thumb in determining whether skilled care is required to prevent or slow deterioration in a patient’s condition. Thus, such coverage depends not on the beneficiary’s … [Read more...] about Know Jimmo | Medicare Has Never Supported an “Improvement Standard” Rule-Of-Thumb
Search Results for: maintenance
Know Jimmo | More Outpatient Therapy
The Center for Medicare Advocacy is often asked in what care settings the Jimmo Settlement applies. Jimmo applies to skilled care – nursing and therapy (physical, occupational and speech language pathology) – received in a skilled nursing facility, … [Read more...] about Know Jimmo | More Outpatient Therapy
Know Jimmo | Outpatient Therapy
Jimmo applies to outpatient therapy Services, too - Skilled therapy to maintain or slow decline is NOT limited, and the cap on outpatient therapy was repealed in 2018. As CMS stated in its February 2024 reminders to Providers and Contractors: … [Read more...] about Know Jimmo | Outpatient Therapy
Know Jimmo | “‘Plateaued’ is not a medical description”
The following is an excerpt from a May 28, 2024 article in McKnight's Long Term Care by Jean Wendland Porter, Regional Director of Therapy Operations at Diversified Health Partners in Ohio. “I don’t want to risk my license by continuing therapy … [Read more...] about Know Jimmo | “‘Plateaued’ is not a medical description”
Nursing Home Roundup, May 2024
Congress is active in nursing home issues. H.J. Res 139, filed May 10, 2024 under the Congressional Review Act, disapproves the final minimum staffing rule for nursing homes. Nurse aide training rules are also under attack. On May 16, 2024, the … [Read more...] about Nursing Home Roundup, May 2024
Know Jimmo | You Do Not Have to Decline
You do not have to decline in order to receive Medicare coverage for care to maintain or slow decline Too often Medicare beneficiaries are told the care they are receiving to maintain their condition has to end and, if they decline, then they can … [Read more...] about Know Jimmo | You Do Not Have to Decline
Know Jimmo | CMS Reiterates that Medicare Coverage is Available to Maintain Function or Slow Decline
See MLN Connects Newsletter (2024-02-08-MLNC, 2/8/2024) “Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to … [Read more...] about Know Jimmo | CMS Reiterates that Medicare Coverage is Available to Maintain Function or Slow Decline
Know Jimmo | New CMS Implementation Activity!
CMS Joins the Center for Medicare Advocacy to Advance Access to Medicare-Covered Skilled Care to Maintain One’s Condition or Slow Decline In 2011, the Center for Medicare Advocacy and Vermont Legal Aid brought the Jimmo v. Sebelius class … [Read more...] about Know Jimmo | New CMS Implementation Activity!
Know Jimmo | Priscilla’s Sister
The Jimmo Settlement Could Help Priscilla’s Sister Continue Therapy My sister, who has an Alzheimer’s diagnosis, has been refused continuation of PT by the home care provider…They have discharged my sister from PT saying they will tell caregivers … [Read more...] about Know Jimmo | Priscilla’s Sister
Insurance Industry Group Issues Misleading Medicare Advantage Report
Report Suggests Medicare Could Save Money by Providing as Little Care as Private Medicare Advantage Plans Do, While Ignoring the Harm to Beneficiaries, Overpayments to the Private Plans, and Damage to Medicare’s Solvency On November 24, 2023, the … [Read more...] about Insurance Industry Group Issues Misleading Medicare Advantage Report