Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

The Improvement Standard

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

The Jimmo v. Sebelius Settlement Agreement: An Issue Brief for Medicare Providers

January 2020 Download this Brief Table of Contents What is the Jimmo Settlement Agreement? Does Jimmo Apply to My Practice? What Does Jimmo Mean for My Patients? Are Providers Implementing Jimmo? How Do PDPM and … [Read more...] about The Jimmo v. Sebelius Settlement Agreement: An Issue Brief for Medicare Providers

Jimmo Implementation Council Meets to Discuss the State of Skilled Maintenance Care

On November 20, the Center for Medicare Advocacy, with support from the John A. Hartford Foundation, convened an online gathering of members of the Jimmo Implementation Council and other stakeholders in the effort to remove barriers to care for … [Read more...] about Jimmo Implementation Council Meets to Discuss the State of Skilled Maintenance Care

You Do Not Have to Improve! New Jimmo Resources for Appealing Medicare Denials in Nursing Homes

Medicare coverage of nursing home care depends on a resident’s need for skilled nursing and/or therapy, not the resident’s potential for improvement. However, too many nursing home residents continue to be denied skilled services on the basis of an … [Read more...] about You Do Not Have to Improve! New Jimmo Resources for Appealing Medicare Denials in Nursing Homes

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 *