As many of you may know, a class action lawsuit involving Medicare payments for nursing home and in-home care was settled earlier this year. In that lawsuit, Jimmo v. Sebelius, the application of Medicare’s “Improvement Standard” which was being used to cut off Medicare benefits for patients receiving nursing home or in-home care was challenged. Under the terms of the settlement, the government agreed to that patients could no longer be cut off from Medicare benefits for the reason that the patient was no longer making any progress toward recovery, if the patient continued to need such care to prevent or slow further deterioration.
The Centers for Medicare and Medicaid Services has now issued a fact sheet regarding the settlement (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf). Should a facility or provider attempt to cut off services based upon the Improvement Standard, this factsheet can be used to show that such services should be covered.