In 2013, the Center for Medicare Advocacy and Vermont Legal Aid, along with additional counsel provided by Wilson Sonsini Goodrich & Rosati, settled a lawsuit with the Medicare program (the named defendant,...
Jimmo succeeds in getting Medicare coverage, two years after landmark case ended
By
Tim Mullaney
Oct 31, 2014
Glenda Jimmo has reached a settlement with the federal government and will finally receive Medicare coverage for claims that were denied in 2007, which led her to file a class-action lawsuit over the so-called...
Jimmo implementation is troubled, long-term care expert says
By
Tim Mullaney
Apr 30, 2014
Skilled nursing providers remain confused about Medicare changes related to the Jimmo v. Sebelius legal settlement, and many beneficiaries are not aware that their therapy might now be eligible for coverage,...
Jimmo guidance: Document whether therapy is for restoration or maintenance before providing care
By
Tim Mullaney
Dec 20, 2013
In seeking Medicare reimbursement, skilled nursing facilities should not claim that therapy was to maintain a patient’s condition if documentation reflected only an improvement goal, according to...
CMS updates Medicare manual to reflect Jimmo settlement
By
Tim Mullaney
Dec 10, 2013
The Centers for Medicare & Medicaid Services has revised the Medicare Benefit Policy manual to clarify that skilled care and skilled therapy may be covered even for conditions that will not improve, per...
Jimmo and the future of rehab
By
Shelly Mesure, MS, OTR/L
Nov 07, 2013
On Jan. 24 of this year, the Jimmo vs. Sebelius class action lawsuit was settled. This was a significant win for us, the healthcare providers. As we continue to work out the details, I feel now is a good...
CMS fact sheet gives rules on ‘maintenance’ caregiving
By
James M. Berklan
May 01, 2013
The Centers for Medicare & Medicaid Services has issued a fact sheet, that clarifies the conditions the terms under which “maintenance therapy” will be covered by Medicare.
Medicare coverage of ‘maintenance therapy’ determined by need for skilled care, CMS clarifies...
By
McKnight's Staff
Apr 16, 2013
Providers must sufficiently document the need for skilled care in order to obtain Medicare coverage for so-called “maintenance therapy,” the Centers for Medicare & Medicaid Services stressed...
The mythical standard
By
McKnight's Staff
Mar 01, 2013
The Jimmo vs. Sebelius case, filed in January 2011 in federal district court in Vermont, has now been settled. The class action lawsuit challenged Medicare’s use of an “improvement standard”...
Settlement will expand therapy
By
James M. Berklan
Mar 02, 2013
It’s official: A federal judge approved a settlement agreement the last week of January that will allow Medicare patients to continue receiving therapy services even if they are not making measurable...