On January 24, 2013, the Chief Judge of Vermont’s U.S. District Court gave her approval during a scheduled fairness hearing for an ‘improvement standard’ settlement (Jimmo v. Sebelius). This settlement could lead to more long-term care in the home health setting and open the benefit to patients who were previously denied coverage.
According to The Center for Medicare Advocacy, that helped litigate the case on behalf of beneficiaries, “With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatients settings. CMS must also develop and implement 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 underlying conditions will not improve.”
It should be noted that the Settlement Agreement standards for Medicare coverage of skilled maintenance services applies immediately, The Center of Medicare Advocacy encourages people to appeal should they be denied Medicare coverage for skilled maintenance nursing or therapy because they are not improving.
For more information read, Judge Approves Settlement in Jimmo vs. Sebelius After Court Hearing
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