Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

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Updated Factsheet: Medicare Skilled Nursing Facility Coverage Does Not Require Improvement

In 2013, a federal district court approved a settlement agreement in the case of Jimmo v. Sebelius that confirmed Medicare coverage should be determined by a beneficiary’s need for skilled care, not the individual’s potential for improvement. The … [Read more...] about Updated Factsheet: Medicare Skilled Nursing Facility Coverage Does Not Require Improvement

Jimmo Update: CMS Reminds Providers and Contractors of Medicare Coverage to Maintain or Slow Decline

Skilled nursing care and skilled therapy services for beneficiaries who need skilled care to maintain function or to prevent or slow decline is covered by Medicare. That is the message of reminders issued by the Centers for Medicare & Medicaid … [Read more...] about Jimmo Update: CMS Reminds Providers and Contractors of Medicare Coverage to Maintain or Slow Decline

Medicare Covers Maintenance Therapy – Therapist Assistants Can Provide It

The Center for Medicare & Medicaid Services issued MLN Matters # MM-11721 on May 1, 2020. Effective January 1, 2020, the MLN, reconfirms that therapy to maintain an individual’s function is a Medicare-covered service. Further, the MLN authorizes … [Read more...] about Medicare Covers Maintenance Therapy – Therapist Assistants Can Provide It

Incorrect Implementation of the Jimmo V. Sebelius Settlement in a Skilled Nursing Facility: A Case Study

January 2020Download this Case Study I. Background - The Jimmo Settlement In 2013, a U.S. District Court approved the settlement agreement in Jimmo v. Sebelius,[1] requiring the Centers for Medicare & Medicaid Services (CMS) to confirm … [Read more...] about Incorrect Implementation of the Jimmo V. Sebelius Settlement in a Skilled Nursing Facility: A Case Study

Expedited/Fast-Track Medicare Appeals in Skilled Nursing Facilities in Light of the Jimmo v. Sebelius Settlement Agreement *

Background The United States District Court for the District of Vermont approved a settlement agreement in Jimmo v. Sebelius[1] on January 23, 2013. The Jimmo Settlement required the Centers for Medicare & Medicaid Services (CMS) to confirm … [Read more...] about Expedited/Fast-Track Medicare Appeals in Skilled Nursing Facilities in Light of the Jimmo v. Sebelius Settlement Agreement *

Self-Help Resources for Improvement Standard Denials – August, 2019

Medicare coverage of skilled nursing and/or therapy services depends on a beneficiary’s need for the skilled care, not on the individual’s potential for improvement. The Settlement Agreement in Jimmo v. Sebelius, approved by a federal district court … [Read more...] about Self-Help Resources for Improvement Standard Denials – August, 2019

Medicare Coverage In Light of Jimmo v. Sebelius For Providers, Contractors, and Adjudicators

With support from The John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Fact Sheet to help Medicare providers, contractors, and adjudicators apply the correct legal standard to Medicare coverage and payment … [Read more...] about Medicare Coverage In Light of Jimmo v. Sebelius For Providers, Contractors, and Adjudicators

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