CMS Updates and Adds Resources to Jimmo Settlement Agreement Webpage

The Centers for Medicare and Medicaid Services (CMS) has added resources regarding Medicare coverage to help people who need skilled maintenance nursing or therapy, including a new webpage containing important information about the Jimmo Settlement.

As LeadingAge NY has reported since 2013, the Jimmo case clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a patient needs skilled care to maintain function or to prevent or slow decline or deterioration.

The Jimmo Settlement changed practice for providers and contractors who may have incorrectly believed that the Medicare program covers nursing and therapy services under these benefits only when a patient is expected to improve. The settlement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech), and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

The Center for Medicare Advocacy, Inc, a national nonprofit, nonpartisan law organization that provides education, advocacy, and legal assistance to help older people and people with disabilities obtain access to Medicare and quality health care, has created a toolkit to be used as a resource for providers.

Contact: Mary Wassel, mwassel@leadingageny.org, 518-867-8850