Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

The Improvement Standard

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

Jimmo Implementation: Beneficiary Successfully Appeals Denial of Maintenance Therapy

Despite the Jimmo case’s confirmation that Medicare coverage of a stay in a skilled nursing facility (SNF) is appropriate to maintain a resident’s functional status, when the nursing or therapy services must be provided by a professional nurse or … [Read more...] about Jimmo Implementation: Beneficiary Successfully Appeals Denial of Maintenance Therapy

Checklist for Medicare Nursing Home “Improvement Standard” Denials

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for skilled nursing facility care based on an … [Read more...] about Checklist for Medicare Nursing Home “Improvement Standard” Denials

Checklist for Medicare Home Health Care “Improvement Standard” Denials

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy has produced a new Checklist to help Medicare beneficiaries and their families respond to unfair Medicare denials for home health care based on an erroneous … [Read more...] about Checklist for Medicare Home Health Care “Improvement Standard” Denials

Center for Medicare Advocacy Survey: CMS’ Jimmo v. Sebelius “Improvement Standard” Education Still Not Working

The Center for Medicare Advocacy recently completed a survey of Jimmo v. Sebelius stakeholders to analyze the effectiveness of the Centers for Medicare & Medicaid Services’ education efforts regarding the Jimmo Settlement, which clarified … [Read more...] about Center for Medicare Advocacy Survey: CMS’ Jimmo v. Sebelius “Improvement Standard” Education Still Not Working

New Jimmo Resources from the Center for Medicare Advocacy and The John A. Hartford Foundation

With support from The John A. Hartford Foundation, the Center for Medicare Advocacy has produced two new Checklists to help Medicare beneficiaries and their families respond to unfair Medicare denials based on an erroneous “Improvement … [Read more...] about New Jimmo Resources from the Center for Medicare Advocacy and The John A. Hartford Foundation

Fact Sheet – Medicare Home Health Coverage In Light of Jimmo v. Sebelius

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy provides the following Fact Sheet to help Medicare home health beneficiaries and their families respond to unfair Medicare denials based on an erroneous … [Read more...] about Fact Sheet – Medicare Home Health Coverage In Light of Jimmo v. Sebelius

Fact Sheet – Skilled Nursing Facility Coverage and Jimmo v. Sebelius

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy provides the following Fact Sheet to help Medicare nursing home beneficiaries and their families respond to unfair Medicare denials based on an erroneous … [Read more...] about Fact Sheet – Skilled Nursing Facility Coverage and Jimmo v. Sebelius

Administrative Law Judge Rules Medicare Covers Outpatient Therapy to Maintain Function, Indefinitely if Needed

A young man who suffered a traumatic brain injury (TBI) following a fall in 2008 was receiving outpatient physical therapy three times a week.  While his therapy was originally covered by his Medicare Advantage (MA) plan, the plan denied further … [Read more...] about Administrative Law Judge Rules Medicare Covers Outpatient Therapy to Maintain Function, Indefinitely if Needed

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