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In an Opinion and Order released on August 18, 2016, Chief Judge Christina Reiss, the judge in Jimmo v. Burwell – the “Improvement Standard case” – ordered the federal government, through its Centers for Medicare & Medicaid Services (CMS), to comply with the Settlement Agreement that she approved in January 2013.

The Order requires CMS to remedy the inadequate Educational Campaign that was a cornerstone of the original Settlement Agreement. The Secretary of Health & Human Services must propose corrective action for consideration by the plaintiffs in the case within 45 days of Judge Reiss’ Order. As the Judge stated, “Plaintiffs bargained for the accurate provision of information regarding the maintenance coverage standard and their rights under the Settlement Agreement would be meaningless without it.

The Plaintiffs in the case have provided proof to CMS since January 2014 that the agency’s Educational Campaign failed to communicate the necessary information to the providers and contractors that make the front-line decisions in the Medicare program.

The Center for Medicare Advocacy will be working with CMS to renew and enhance education about Medicare coverage for skilled maintenance nursing and therapy.  We also continue to encourage people to appeal if they are told Medicare coverage is not available for skilled care because they are not improving.

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