A settlement agreement in Jimmo v. Sebelius required the Secretary of Health and Human Services to follow a “maintenance coverage standard” under which skilled nursing services would be covered by Medicare if they were necessary to maintain the patient’s current condition or prevent deterioration, rather under a so called “improvement standard.” The federal district court for the District of Vermont found that the Secretary had not complied with the settlement agreement with respect to implementing an educational campaign through which the Secretary would communicate the new standards to providers and contractors.

On February 2, 2017, the federal court ordered the Secretary to implement a corrective action plan to remedy the noncompliance that includes publishing a corrective statement disavowing the improvement standard, conducting a national call with providers to better explain the new maintenance standard, maintaining a dedicated Jimmo website with FAQs, and providing heightened training for contractors to make coverage decisions.
You can read more about the federal court decision and the Jimmo case at the below link.

Center for Medicare Advocacy

Share on LinkedInShare on FacebookTweet about this on TwitterShare on Google+Pin on PinterestShare on RedditDigg thisShare on StumbleUponBuffer this pageShare on TumblrEmail this to someone
About Jerry

Jerold E. Rothkoff, a practicing New Jersey and Pennsylvania attorney, is the Principal of the Rothkoff Law Group, an elder care law firm. Jerry dedicates his practice to serving clients in the areas of life care planning, long-term care planning, Medicaid & VA benefits, and advocacy for the elderly and disabled. He is past President of the NJ Chapter of the National Academy of Elder Law Attorneys, former chair of the elder law section of the NJ State Bar Association, and past President of the Life Care Planning Law Firm Association. Jerry continues to be an outspoken advocate for the rights of the elderly and disabled. He writes for and gives presentations regularly to attorneys and other professionals about legal issues related to seniors and those with disabilities. Jerry’s community activities include the Twilight Wish Foundation, the Delaware Valley Stroke Council, the Alzheimer’s Association, as well as numerous other advocacy groups. When not in the office, Jerry spends time with his wife, Erica, and their five children, eighteen-year old identical twin girls, Liza and Julia, fifteen-year old fraternal twin boys, Evan and Gregory, and six-year old Aitan.

Leave a Reply