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Medicare coverage of nursing home care depends on a resident’s need for skilled nursing and/or therapy, not the resident’s potential for improvement. However, too many nursing home residents continue to be denied skilled services on the basis of an “Improvement Standard,” which was firmly rejected by the court-approved settlement in Jimmo v. Sebelius. In order to help nursing home residents and their families challenge these unfair denials, the Center for Medicare Advocacy (the Center) has developed a host of general and setting-specific resources about Medicare appeals in light of the Jimmo Settlement.

Continuing this effort, the Center is pleased to announce the publication of our latest resource, an article entitled “Expedited/Fast-Track Appeals in Skilled Nursing Facilities in Light of the Jimmo v. Sebelius Settlement Agreement.” This article was written for California Advocates for Nursing Home Reform (CANHR) and was published in the Fall 2019 issue of Legal Network News. The article provides an in-depth discussion on filing expedited or fast-track Medicare appeals and offers guidance on supporting a resident’s argument against Medicare termination.

In addition to the publication of our article, the Center is pleased to announce the release of our Jimmo Appeal Letter Template. The Letter Template addresses the Jimmo Settlement and provides guidance to SNF residents (or their representatives) about what information should be included in an appeal request.

October 28, 2019 – D. Valanejad

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