With support from the John A. Hartford Foundation, the Center for Medicare Advocacy (CMA) has created a council of beneficiary advocates, providers, policy-makers and other partners to discuss, analyze and advance the implementation of the Jimmo v. Sebelius “Improvement Standard” settlement.
The January 13, 2013 Jimmo federal court settlement invalidated the Medicare improvement standard. The settlement agreement clearly states that qualification for Medicare coverage turns on the beneficiary’s need for skilled care (nursing or therapy), not on his or her potential for improvement. The settlement applies to Medicare coverage for home health care, skilled nursing facility services, outpatient therapies, and to some extent, care provided by inpatient rehabilitation facilities.
Unfortunately, even though Jimmo is the law of the land, beneficiaries are still being denied Medicare coverage based on an improvement standard.
Therefore, CMA convened the first meeting of the Jimmo Implementation Council on June 23, 2015 at the Capitol in Washington, DC. Jerry Rothkoff was honored to be among the approximately 50 invited Council members throughout the country. The purpose of the group is to form a community of experts committed to working together to develop strategies to implement the Jimmo decision.
At the first meeting, the group discussed the pervasive myth of improvement, barriers to implementation of Jimmo, and effective methods of implementing the decision, so that all Medicare beneficiaries who should receive skilled maintenance care are able to access those essential services.
Jerry will provide further updates on future Council meetings later this year.