Home Health & Hospice

Q: Can you offer some background information on Jimmo v. Sebelius?

Homecare Insider, January 6, 2014

Q: Can you offer some background information on Jimmo v. Sebelius?

A: On January 24, 2013, a settlement in the Medicare Improvement Standard case, Jimmo v. Sebelius, was approved marking a huge step forward for thousands of beneficiaries nationwide, according to the Center for Medicare Advocacy.

Glenda Jimmo of Lincoln, Vt., was the lead plaintiff in a class-action suit filed after Medicare denied her coverage for nurses and home health aides because her condition was “unlikely to improve.” Following this settlement, Medicare coverage is available for skilled maintenance services in the home health, nursing home, and outpatient settings and CMS must now revise its Medicare Benefit Policy Manual, along with a number of other policies, guidelines, and instructions.

CMS is also tasked with developing and implementing a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their conditions will not improve. While CMS works on the education campaign and its policy revisions, the standards for Medicare coverage of skilled maintenance services are effective immediately.

Read more on the Center for Medicare Advocacy website.

CMS released a fact sheet after the settlement. The fact sheet spells out what CMS’ plans are for clarifying the policy and educating providers. According to the document, CMS will complete the manual revisions and educational campaign by January 23, 2014, which is within one year of the approval date of the settlement agreement.

Read the fact sheet today.