Home Health, News, Skilled Nursing Facility

Medicare to better explain maintenance therapy coverage, reject Improvement Standard

A plan proposed by the Department of Health and Human Services (HHS) has been accepted by a judge, ending the Jimmo v. Sebelius legal battle. The plan comes after plaintiffs of the case filed a motion in March of 2016, claiming that the Secretary had failed to meet requirements of the Jimmo Settlement Agreement, which included a mandate that the Secretary “engage in a nationwide educational campaign” to better explain the maintenance therapy coverage standard. In their motion, plaintiffs argued that the attempts at educating beneficiaries was confusing, inaccurate, and did not change coverage standards for Medicare beneficiaries.

In a legal order filed on February 1, 2017, two additional requirements were assigned to the Secretary, and will be answered in HHS’ proposed plan. Aspects of the proposed corrective action plan include:

  • Officially denying the “Improvement Standard,” which will clarify that Medicare beneficiaries cannot be denied coverage if their condition has not or isn’t expected to improve.
  • Publication of public documents from the Jimmo settlement on a webpage to be found on cms.gov, a Frequently Asked Questions (FAQs) webpage, and additional information clarifying the changes to Medicare coverage.
  • An educational campaign including oral statements explaining Medicare coverage changes at the beginning of Open Door Forums, a new National Call, new training for the staffs of Medicare Administrative Contractors (MACs) and Medicare Advantage Organizations (MAOs), and additional monitoring of the corrective action plan and FAQs conducted by counsel.