In Articles, Uncategorized

Medicare Coverage
In Light of Jimmo v. Sebelius
For Providers, Contractors, and Adjudicators
Beneficiaries do not have to improve to qualify for Medicare coverage!

On January 24, 2013, a U.S. District Court approved the settlement agreement in Jimmo v. Sebelius, No. 5:11-CV17
(D. VT). As a result of the Jimmo Settlement, the Centers for Medicare & Medicaid Services (CMS) was
required to confirm that Medicare coverage is determined by a beneficiary’s need for skilled care, not on a
beneficiary’s potential for improvement. Medicare policy now clearly states that coverage “does not turn on the
presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled
care. Skilled care may be necessary to improve a patient’s condition, to maintain a patient’s current condition, or
to prevent or slow further deterioration of the patient’s condition.” (CMS Transmittal 179, Pub 100-02, 1/14/2014). Read More

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