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Thank you to everyone who took the time to complete our recent Jimmo Implementation Council survey. We are writing to provide a summary of the results and the status of our efforts. In summary, there is enthusiasm for staying in touch and continuing to work together to advance implementation of the Jimmo Settlement.  96% of … Read more

Advancing Access to Medicare and Necessary Care for People with Long-Term Conditions and Injuries With support from the John A. Hartford Foundation the Center for Medicare Advocacy has created a multi-disciplinary Jimmo Implementation Council. The Center convened the first meeting of the Council on June 23, 2015 at the US Capitol in Washington, DC.[1] The … Read more

Advancing Access to Medicare and Necessary Care for People with Long-Term Conditions and Injuries                                                                                      … Read more

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy 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 Center convened the first meeting of the multi-disciplinary Council on June 23, 2015 at … Read more

Thank you for your interest in the Jimmo Implemenation Council. We look forward to your insight as we move forward with Implementation of the Jimmo v. Sebelius settlement. Stay tuned for updates and further activities. More information on the Improvement Standard and Jimmo v. Sebelius.

No. 5:14-cv-128 (D.Vt.), filed June 23, 2014 Issue: Whether the denial of coverage for named plaintiff Glenda Jimmo by the Medicare Appeals Council on re-review of her claim under the revised manual provisions pursuant to the Jimmo settlement agreement was correct. Relief Sought: Reversal of the Secretary’s decision denying coverage and granting the claim for … Read more

No. 11-cv-17 (D.Vt.), filed January 18, 2011 Issue: Whether the "Improvement Standard", which operates as a rule of thumb to terminate or deny Medicare coverage to beneficiaries who are not improving, violates substantive and procedural requirements of the Medicare statute, the Administrative Procedure Act, and the Freedom of Information Act, and the Due Process Clause of … Read more

Twenty-one months after winning a national class action lawsuit that sought to overturn Medicare's practice of denying skilled maintenance care to patients who did not meet an "improvement standard," plaintiff Glenda Jimmo is finally receiving Medicare coverage for skilled home health maintenance care benefits she was denied in 2007. A federal court case in Vermont … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  Re-Review of Previously Denied Claims Pursuant to the Jimmo Settlement (Gill Deford) Overview Claims Eligible for Review Deadlines and Request Form Legislative Update:  The Federal Budget and Medicare (David Lipschutz) Medicare “Doc Fix” (Physician payment, or “SGR”): Where are we now? Extenders: QI program and therapy cap exceptions … Read more

1. PRESENTATION:  RE-REVIEW OF PREVIOUSLY DENIED CLAIMS PURSUANT TO THE JIMMO SETTLEMENT In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. Sebelius provides that Medicare beneficiaries who were previously denied Medicare coverage may have claims re-reviewed under the revised manual provisions.  The … Read more

If you are covered by Medicare and you have a long-term or chronic condition, you may be eligible to have Medicare re-review your claims that were denied in prior years.  Please read carefully. In addition to revising Medicare manual provisions to now allow Medicare coverage for skilled maintenance care, the Settlement Agreement in Jimmo v. … Read more

As of December 6, 2013, Centers for Medicare & Medicaid Services (CMS) Policy manuals have been updated to reflect the settlement in Jimmo vs. Sebelius, No.11-cv-17 (D.VT, January 24, 2013).  The manuals now make it clear that improvement is not necessary for coverage of skilled nursing and therapy services. For example, the home health section … Read more

1. PRESENTATION: CMS MANUAL PROVISIONS ISSUED PURSUANT TO THE JIMMO SETTLEMENT The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised pursuant to the Jimmo vs. Sebelius Settlement.  The Jimmo case ended a longstanding practice denying Medicare coverage to people who had “plateaued,” or were “chronic,” or “stable,” or “not … Read more

Monday, December 16, 2013 – 2:00 P.M., Eastern Time Call-in Number: 1 (888) 206-2266 Pass Code: 9874704 NOTE: We ask people calling from the same location to gather around one telephone.  This frees up lines and holds down costs. Please ensure your line is on MUTE for the duration of the call until the Q&A portion of … Read more

  Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the "Improvement Standard" case, Jimmo v. Sebelius, No. 11-cv-17 (D.VT), filed January 18, 2011.  A proposed settlement agreement was filed in federal District Court on October 16, 2012.  When the judge approves … Read more

(print stories only) Mrs. Jimmo Lead plaintiff in the Improvement Standard case, Glenda Jimmo of Bristol, Vermont is blind and has had her right leg amputated due to complications from diabetes. She requires a wheelchair, and receives multiple home health care visits per week for various treatments for her complex condition. However, Medicare denied coverage … Read more

FREQUENTLY ASKED QUESTIONS ABOUT JIMMO SETTLEMENT What Does the Jimmo Settlement Agreement Mean? A: The Jimmo agreement settles once and for all that Medicare coverage is available for skilled services to maintian an individual’s condition.  Under the maintenance coverage standard articulated in the Jimmo Settlement, the determining issue regarding Medicare coverage is whether the skilled services of a health care professional are needed, not whether … Read more

1.  PRESENTATIONS UPDATE ON JIMMO:  SETTLEMENT APPROVED In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a lawsuit in the District Court of Vermont challenging Medicare’s “Improvement Standard.” Jimmo v. Sebelius No. 11-cv-17 (D.Vt., filed 1/18/11). This case argues that the "Improvement Standard", which operates as a rule of thumb to … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Presentation:  The Road Forward on Jimmo: Post-Approval Update on the Improvement Standard Litigation – Jimmo v. Sebelius  (Judith Stein) Presentation: Update on Medicare Secondary Payor (MSP): CMS to Establish a New Website For Medicare Secondary Payer Claims Information (Alfred Chiplin) Legislative Update:  The Federal Budget and Medicare (David Lipschutz) … Read more

1.  PRESENTATIONS UPDATE ON JIMMO: THE IMPROVEMENT STANDARD CASE In January 2011, the Center for Medicare Advocacy and Vermont Legal Aid filed a lawsuit in the District Court of Vermont challenging Medicare’s “Improvement Standard.” Jimmo v. Sebelius No. 11-cv-17 (D.Vt., filed 1/18/11). This case argues that the "Improvement Standard", which operates as a rule of … Read more

Based on an article by Judith A. Stein, Executive Director, Center for Medicare Advocacy, Copyright © 2013 Bloomberg BNA (2/2013). Mrs. “P” was 68 years old and living with Amyotrophic Lateral Sclerosis (ALS, commonly known as Lou Gehrig's disease) when she contacted the Center for Medicare Advocacy. She needed a wheelchair, was unable to stand … Read more

Completion of legal process for beneficiaries with long-term and chronic conditions  January 24, 2013 – Mansfield, Conn. – The Center for Medicare Advocacy, along with its co-counsel Vermont Legal Aid are pleased that the Settlement Agreement in the Medicare Improvement Standard case, Jimmo v. Sebelius, was approved today at the conclusion of a scheduled fairness … Read more

Over 50 Million Americans Rely on Medicare.     We've got their backs.   Will you have ours?     For over 26 years, The Center for Medicare Advocacy has been a tireless advocate for Medicare beneficiaries — both for individuals and entire classes.  The Center has also fought to preserve our nation's Medicare program which, since … Read more

Medicare: Just the Facts! Misinformation about Medicare and the Affordable Care Act is widespread and increasing as the election nears.  Below, we try to dispel misinformation and base discussions on a factual foundation.  Spread the word. Help set the record straight! The Fact Here's Why The Affordable Care Act does NOT cut Medicare for beneficiaries. … Read more

Updated Improvement Standard and Jimmo News from CMS

CMS Issues Fact Sheet Outlining Jimmo v. Sebelius Settlement.  See Details Below – Fact Sheet; CMS.gov Jimmo Search result; CMS Cover Letter to Medicare Advantage Organizations, Medicare Advantage-Prescription Drug, Section 1876 Cost Organizations, and PACE Plans.  For more on the Improvement Standard and Jimmo v. Sebelius, see our full Improvement Standard page.

Skilled Maintenance Services Are Covered by Medicare. The Center for Medicare Advocacy is pleased to announce that the Medicare Policy Manuals have been revised. The revisions, pursuant to the Jimmo vs. Sebelius Settlement, clarify that improvement is not required to obtain Medicare coverage.  The revisions were published by the Centers for Medicare & Medicaid Services (CMS) on Friday December 6, 2013. They … Read more

In December 2015, the Senate Finance Committee’s Bipartisan Chronic Care Working Group released a Policy Options Document.  The Policy Options Document was issued as part of a process begun in May 2015 to develop legislation to address challenges facing Medicare beneficiaries with chronic conditions.   According to a press release issued by the Committee, the Options … Read more

January 29, 2016 The Honorable Orrin Hatch                                       The Honorable Ron Wyden Chair, Committee on Finance                                    Ranking Member, Committee on Finance United States Senate                                               United States Senate Washington, D.C. 20510                                           Washington, D.C. 20510 The Honorable Johnny Isakson                                 The Honorable Mark Warner United States Senate                                               United States Senate Washington, D.C. 20510                                           Washington, DC 20510 Submitted electronically to: chronic_care@finance.senate.gov Re: Comments … Read more

Skilled nursing facilities (SNFs) often tell Medicare beneficiaries and their families that they intend to “discharge” a Medicare beneficiary because Medicare will not pay for the beneficiary’s stay under either Part A (traditional Medicare) or Part C (Medicare Advantage).  Such a statement unfortunately misleads many beneficiaries into incorrectly believing, not only that Medicare has decided … Read more

Home Health

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When does Medicare cover home health care? What services are covered? What if I attend religious services once a week; am I still considered "homebound" for the purpose of Medicare coverage? The home health agency told me my aide services would be reduced. My doctor hasn’t given me this information. What are my rights? For … Read more

Introduction to the Center's Under-65 Project Introduction to Medicare for People Under 65 Jimmo v. Sebelius: What it Means for Coverage Durable Medical Equipment FREE Webinar Series – Participate Live or Watch Recordings Additional Resources from Medicare, Social Security and more Articles and Updates Pursuant to a grant from the U.S. Department of Health and Human … Read more

October 14, 2015 Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building 200 Independence Ave., S.W. Washington, D.C.  20201 Medicare and Medicaid Programs; Reform of Requirements for long-Term Care Facilities CMS-3260-P Submitted electronically:  http://www.regulations.gov Dear Mr. Slavitt and CMS Colleagues: The … Read more

Based on recent experience, the Center for Medicare Advocacy provides this Practice Tip for providers and advocates for patients who need to change from an improvement mode to maintenance mode for nursing or therapy. The Center is seeing decisions from Medicare Contractors requiring that providers obtain new orders when a patient’s goals change to maintenance … Read more

September 1, 2015 SUBMITTED ELECTRONICALLY http://www.regulations.gov Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services 200 Independence Avenue, SW Washington, DC 20201 Re: CMS-1625-P Dear Acting Administrator Slavitt: The Center for Medicare Advocacy (the Center) is pleased to provide comments on the Centers for Medicare & Medicaid Services … Read more

Another Barrier for Jimmo implementation that may not yet have percolated to the top is the Medicare fee schedule rates for rehabilitation services negatively impacting providers willingness to not only risk providing services for fear of denials and recoupments, but also because payment rates may not sufficiently cover expenses with current and pending Medicare fee schedule … Read more

While the Medicare Act covers physical, speech, and occupational therapies in various community-based and facility settings, coverage is often denied or inappropriately limited.  Most often, this is because the individual requires therapy to maintain her condition, or slow deterioration. When an individual is not going to improve, providers too often decline to provide therapy or … Read more

No. 14-1519 (APM) (D.D.C.), filed Sept. 5, 2014 Amicus information: Amici are the Center and the National Health Law Program.  They are supporting the claim of Medicare beneficiaries that they should be covered for a form of testing that would assist in the diagnosis of patients suffering from dementia. Issues: Whether a diagnostic test (PET … Read more

1. Comments to Senate Finance Committee Chronic Care Workgroup On June 22, 2015, the Center for Medicare Advocacy submitted comments to the Senate Finance Committee Chronic Care Workgroup in response to the Committee’s May 22, 2015 request for comments on reforming care for individuals with chronic conditions. The Committee identified three overarching goals to guide … Read more

June 22, 2015 The Honorable Orrin Hatch                                        The Honorable Ron Wyden Chair, Committee on Finance                                     Ranking Member, Committee on … Read more

By Douglas Gould, President, Douglas Gould and Company Medicare has done so much good over the last 50 years, but it needs a tough watchdog to keep it effective in the years to come. Case in point would be the so called “Improvement Standard,” in which care managers and other Medicare decision-makers determined that benefits … Read more

LEGISLATIVE UPDATE 1.Senate Finance Committee Addresses Medicare Appeals System On previous Alliance calls, we have discussed that through the Center’s extensive experience with the Medicare administrative appeals process, we continue to find that: The success rates for beneficiaries at the initial levels of Medicare appeal are dismal; and The average wait for a decision at … Read more

LEGISLATIVE/BUDGET UPDATE 1.Medicare Physician Payment (SGR) In an effort to address the perennial issue of payment for Medicare physicians — the fundamentally flawed reimbursement system known as the sustainable growth rate or SGR – the House of Representatives overwhelmingly passed a “doc fix” package on March 26, 2015 that would repeal and replace the SGR.  … Read more

We are continuously amazed at the courage and empathy of our clients.  The plaintiffs in Jimmo v. Sebelius, a class action lawsuit, filed by the Center for Medicare Advocacy in 2011 and settled in 2013, are remarkable examples of this. The Jimmo Settlement opens doors to Medicare coverage for people with long-term and chronic conditions throughout the country.  … Read more

LITIGATION UPDATE Recent Litigation Victories Bagnall v. Sebelius (Observation Status) No. 3:11-cv-01703 (D. Conn., filed 11/3/2011). In November 2011, the Center for Medicare Advocacy and the National Senior Citizens Law Center filed a class action lawsuit on behalf of individuals who have been denied Medicare Part A coverage of hospital and nursing home stays because … Read more

As part of our recognition of Medicare’s first 50 years, this week begins our Medicare Matters: 50 Insights for Medicare’s 50th Anniversary. Help us spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it. Medicare Was Key to Integrating Hospitals Medicare Reduced Poverty Medicare Saves Lives Medicare’s Future … Read more

Contact:  Ali Bers, Litigation Attorney, Center for Medicare Advocacy               (860) 456-7790, abers@medicareadvocacy.org               Michael Benvenuto, Project Director, Vermont Legal Aid, Inc.               (802) 343-0967, mbenvenuto@vtlegalaid.org Burlington, VT: The Center for Medicare Advocacy and Vermont Legal Aid filed a class action lawsuit against Sylvia Mathews Burwell, the Secretary of Health and Human Services, to stop … Read more

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Last December, Mr. Q’s 91-year old mother suffered a stroke, impairing her ability to speak and swallow.  Her neurologist was clear that with skilled therapy she could regain her abilities, but cautioned it would take time.  He advised that a feeding tube should be inserted so she could receive necessary nutrition while undergoing therapy.  Her … Read more

LEGISLATIVE UPDATE The Year Ahead 1. Legislative & Budget Landscape in a New Congress In the 114th Congress staring in January 2015, Republicans will control both the House of Representatives and the Senate.  What will this mean for health care policy generally and Medicare specifically?  Here are a few different takes: American Enterprise Institute (AEI) briefing … Read more

Welcome and Housekeeping  (David Lipschutz, Moderator) Legislative Update: The IMPACT Act of 2014 (David Lipschutz) Overview  – signed into law by President Obama on October 6, 2014, the Improving Medicare Post-Acute Care for Medicare Beneficiaries Act of 2014 (IMPACT Act, H.R. 4994) requires reporting of standardized data by post-acute care (PAC) providers across different PAC … Read more

1.  LEGISLATIVE UPDATE: THE IMPACT ACT OF 2014 On October 6, 2014, President Obama signed into law the “Improving Medicare Post-Acute Care Transformation Act of 2014” or IMPACT Act.  The bill resulted from a bipartisan, bicameral effort by the House Ways & Means and Senate Finance Committees to address various issues relating to care Medicare … Read more