Judge Gives Official Approval of Jimmo vs Sebelius Settlement

By Margaret Schmidt tags: Medicare

Judge Christina Reiss of the United States District Court of Vermont gave final approval of the Jimmo vs. Sebelius settlement on Thursday, January 24, officially establishing that CMS will “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 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.” The Center for Medicare Advocacy – on behalf of the plaintiffs in the case – heralded the Settlement Agreement as a historic step forward for beneficiaries nationwide.

While CMS begins updating its policy manual and educating administrators, beneficiaries should take note that Medicare coverage for chronic, non-improving conditions that require skilled services is immediately available.

As we reported in December, RehabCare supports the new standard as it will provide access to medically necessary therapy services for chronic conditions such as Multiple Sclerosis, Parkinson’s Disease, spinal cord injury and more.