As RehabCare Advantage recently reported, the United States District Court for the District of Vermont issued a proposed settlement in the Jimmo v. Sebelius case that alleged that the Centers for Medicare & Medicaid Services (CMS) violated its legal obligations by applying an “Improvement Standard” for the provision of Medicare covered therapy services.

According to the proposed settlement, CMS will – among other actions – “revise relevant portions of the Medicare Benefit Policy Manual, after considering input from Plaintiffs’ Counsel, to clarify the coverage standards for the SNF, HH, and OPT [skilled nursing facility, home health services and outpatient therapy] benefits when a patient has no restoration or improvement potential but when that patient needs skilled SNF, HH, or OPT services to maintain his or her condition or prevent or slow further deterioration.”

RehabCare supports the proposed settlement in that it will provide access to medically necessary therapy services for at risk patients, particularly those patients who suffer from chronic conditions such as Multiple Sclerosis, Parkinson’s Disease, spinal cord injury, respiratory disease and contractures. At this time, however, the total implications for the change in policy are unclear.

The settlement is expected to be finalized at a Fairness Hearing scheduled to take place on January 24, 2013.

By Margaret Schmidt