In 2013, the Center for Medicare Advocacy reached a settlement with the Centers for Medicare & Medicaid Services (CMS) in the national class action case, Jimmo v. Sebelius. The Settlement, reaffirmed in 2017, confirmed that beneficiaries do not … [Read more...] about Know Jimmo | Skilled Care & Individual Assessments, Not “Improvement”
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Self-Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials
1. Introduction The Center for Medicare Advocacy has produced this packet to help you understand Medicare coverage and how to file an appeal if appropriate. Medicare is the national health insurance program to which many disabled individuals … [Read more...] about Self-Help Packet for Skilled Nursing Facility Appeals Including “Improvement Standard” Denials
Article Recommends Improvements to Substance Use Disorder Care in SNFs
A recent Health Affairs article, “Improving Access To Substance Use Disorder Care In Nursing Facilities,” outlines the need for comprehensive substance use disorder (SUD) care in nursing facilities. The article also provides an overview of the … [Read more...] about Article Recommends Improvements to Substance Use Disorder Care in SNFs
Another Medicare Quality Improvement Organization Changes Name
Livanta is now Commence Health Beneficiary and Family-Centered Care Quality Improvement Organizations (BFCC-QIOs) help Medicare beneficiaries with their concerns about quality of care, and in filing an appeal if coverage is ending too … [Read more...] about Another Medicare Quality Improvement Organization Changes Name
Know Jimmo | No Improvement Needed
The Jimmo Settlement, approved by the federal district court in 2013, confirmed Medicare coverage should be determined by a beneficiary’s need for skilled care, not the individual’s potential for improvement; and that Medicare covers skilled care to … [Read more...] about Know Jimmo | No Improvement Needed
Know Jimmo | Improvement Isn’t Necessary!
The Jimmo Settlement required the Centers for Medicare & Medicaid to revise its Medicare Benefit Policy Manual "in order to clarify that coverage of skilled nursing and skilled therapy services 'does not turn on the presence or absence of a … [Read more...] about Know Jimmo | Improvement Isn’t Necessary!
Know Jimmo | Medicare Home Health Coverage Does Not Require Improvement
Medicare home health coverage is misunderstood and too often denied. This is particularly true for people with longer-term and chronic conditions who are unable to obtain Medicare coverage although they meet the benefit’s criteria – are homebound and … [Read more...] about Know Jimmo | Medicare Home Health Coverage Does Not Require Improvement
Medicare Quality Improvement Organization Changes Name
Kepro is now Acentra Health Beneficiary and Family-Centered Care Quality Improvement Organizations (BFCC-QIOs) help Medicare beneficiaries with their concerns about quality of care, and in filing an appeal if coverage is ending too soon. As … [Read more...] about Medicare Quality Improvement Organization Changes Name
Know Jimmo | Improvement is Not Required for Medicare Home Health Coverage
The decision regarding coverage should turn on whether skill is needed, not whether the individual is expected to improve. Maintenance nursing is a Medicare-covered service if a nurse is needed to provide or supervise care. Example: … [Read more...] about Know Jimmo | Improvement is Not Required for Medicare Home Health Coverage
Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law
Long-standing Federal regulation makes that clear: “Restoration potential is not the deciding factor in determining whether skilled care is required. Even if full recovery or medical improvement is not possible, a patient may need skilled services … [Read more...] about Know Jimmo | Medicare Denials Due to Lack of Improvement are Contrary to Law