New Issue Brief Clarifies When Medicare Should Cover Skilled Care

This week, the Center for Medicare Advocacy released a new resource on the Medicare Improvement Standard. The issue brief, “Implementing Jimmo v. Sebelius: An Overview,” is intended to provide Medicare stakeholders with an overview of the Jimmo Settlement, what it means in different care settings, and links and references to helpful resource materials.

In 2013, a federal district court approved a settlement agreement in Jimmo v. Sebelius, No. 5:11-CV-17 (D. VT) agreeing that Medicare coverage for skilled nursing or therapy care is not dependent on a beneficiary’s potential for improving under such care. Instead, the coverage depends solely on whether the beneficiary needs the care. The Jimmo Settlement and later court decisions apply to everyone with Medicare throughout the country, regardless of whether an individual is in traditional Medicare or a Medicare Advantage plan.

Despite Jimmo, many people with Medicare and providers still find themselves struggling with its implementation in home health, skilled nursing facility, outpatient therapy, and inpatient rehabilitation hospital settings across the country. They may face denials of care or coverage for legitimate therapies.

These continuing problems make the issue brief a timely resource for people with Medicare, families, providers, contractors, adjudicators, and other stakeholders to learn about the principles articulated in Jimmo. The settlement must be properly implemented in order to ensure proper care is accessible to all people with Medicare, and advocates can use the information to secure that care and coverage.

Read the overview of the Jimmo Settlement.

Read the full issue brief.