Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

The Improvement Standard

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

Guest Post: Jimmo Enforced, Preventive & Maintenance Therapy Affirmed

By John Marmarou, DPT, MSCS - Executive Director, Total Rehab & Fitness For the last 15 years, all of my professional work and efforts have been devoted to keeping those with multiple sclerosis (MS) in their communities and out of the … [Read more...] about Guest Post: Jimmo Enforced, Preventive & Maintenance Therapy Affirmed

New Factsheet | Medicare Home Health Coverage and Jimmo v. Sebelius

Medicare home health coverage can be a crucial resource for individuals with long-term or chronic conditions who continue to reside in their homes. Beneficiaries who meet the qualifying criteria are eligible for home health coverage if the skilled … [Read more...] about New Factsheet | Medicare Home Health Coverage and Jimmo v. Sebelius

Jimmo v. Sebelius 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 Jimmo v. Sebelius Factsheet: Medicare Skilled Nursing Facility Coverage Does Not Require Improvement

Guest Author – The Myth of the Medicare Improvement Standard

The Issue Brief linked below is posted and reprinted with permission of the author, Catherine G. Hopper, Esq. The Center for Medicare Advocacy is grateful to Ms. Hopper not only for permission to reprint, but for her diligence in understanding and … [Read more...] about Guest Author – The Myth of the Medicare Improvement Standard

Medicare Home Health Case Settled with Full Coverage for Beneficiary with Chronic Conditions

Vermont Legal Aid and the Center for Medicare Advocacy are pleased to announce the settlement of McKee v. Azar, a case that was brought in federal court to ensure proper coverage of home health care services for a Medicare beneficiary with multiple … [Read more...] about Medicare Home Health Case Settled with Full Coverage for Beneficiary with Chronic Conditions

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 … [Read more...] about Medicare Covers Maintenance Therapy – Therapist Assistants Can Provide It

Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility Care

New Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility Care The Centers for Medicare & Medicaid Services (CMS) — the federal agency responsible for administering the Medicare program — has begun … [Read more...] about Issue Brief: Medicare Payment vs. Coverage for Home Health & Skilled Nursing Facility Care

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

January 2020 Download 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 … [Read more...] about Incorrect Implementation of the Jimmo V. Sebelius Settlement in a Skilled Nursing Facility: A Case Study

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