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With support from The John A. Hartford Foundation, the Center
for Medicare Advocacy has produced a new Fact Sheet to help Medicare
providers, contractors, and adjudicators apply the correct legal standard to
Medicare coverage and payment determinations – as required by the Jimmo v. Sebelius
Settlement Agreement.
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. The determination of
whether Medicare is available turns on whether skilled personnel must provide
or supervise the care for it to be safe and effective, not on whether the
care is intended to improve the individual’s condition. Medicare-covered
skilled care includes care that improves, or maintains, or slows the decline
of a patient’s condition.
The Jimmo
Fact Sheet includes links to materials written by CMS and approved by the
Jimmo Court; these materials represent official Medicare policy. The Center
for Medicare Advocacy urges providers, contractors, and adjudicators to
utilize these resources whenever Medicare coverage and payment decisions are
made.
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