Medicare Will be Changing Guidelines
In the case of Jimmo v Sebelius the decision was that the settlement should be awarded, thus opening the door for Medicare to provide coverage in therapy for people who would benefit from continued coverage in order to maintain the person's situation or prevent or slow decline.
"With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatient settings. CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve."
The implications for this decision are wide. It can mean that a person who is in skilled nursing care will not suddenly have services withheld as they have "plateaued". Maintenance therapy can also continue at home as long as the person meets other Medicare criteria.
Another important part of this settlement is that it is retroactive. In other words, the case was filed on Jan. 18, 2011. Medicare will be revising its policies and some individuals will be entitled to a re-review of their claims where Medicare services were previously denied.
More will be posted on this web site as Seniors in Transition keeps up to date on Medicare issues as they affect our clients.