Educational Campaign on the Jimmo v. Sebelius "Improvement Standard"

On Thurs. Dec. 19 from 2 -3 p.m. ET, there will be an MLN Connects™ Upcoming Call to discuss what the settlement means for Home Health Agencies (HHA); Skilled Nursing Facilities (SNF); Inpatient Rehabilitation Facilities (IRFs); and providers and suppliers of therapy services under the Outpatient Therapy (OPT) benefit.

As a reminder from CMS, “nothing in this Settlement Agreement modifies, contracts, or expands the existing eligibility requirements for receiving Medicare coverage.”

According to CMS, "the goal of this settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled."

As LeadingAge New York previously reported, the settlement agreement had many conditions which included a series of specific steps for CMS to undertake, such as issuing clarifications to existing program guidance and new educational material on this subject. Please refer to MLN Matters - MM8458 for additional information, and to the latest manual update issued Dec. 6 on coverage as a result of Jimmo vs. Sebelius.

The Dec. 19 call will provide an overview of the clarifications to the Medicare program manuals. The agenda released from CMS includes:

• Clarification of Medicare’s longstanding policy on coverage for skilled services;
• No “Improvement Standard” is to be applied in determining Medicare coverage for maintenance claims that require skilled care; and
• Enhanced guidance on appropriate documentation.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871