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Education Campaign Targets Medicare Providers that Wrongly Deny Coverage on the Basis that Beneficiaries Must Show Improvement


new fact sheet by the Center for Medicare Advocacy on the Jimmo v. Sebilius Settlement Agreement aims to inform Medicare providers and contractors that beneficiaries do not have to improve to qualify for Medicare skilled nursing coverage. The Jimmo Settlement means that Medicare coverage and payment are available for care provided in a skilled nursing facility, home health or outpatient therapy setting when skilled nursing or therapy is required to maintain or slow decline of an individual’s condition.

Although the Jimmo settlement is nearly five years old, many providers remain ignorant of it. According to the Center’s 2018 national survey of providers, 40% of respondents had not heard about the Jimmo Settlement and 30% of respondents were not aware that Medicare coverage does not depend on a beneficiary’s potential for improvement.