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 Federal Court Gives Okay to CMS’ ‘Jimmo’ Corrective Statement

A federal judge in the Jimmo v. Sebelius case accepted the corrective statement that the Centers for Medicare & Medicaid Services (CMS) wrote in order to clarify how Medicare coverage will work for those beneficiaries receiving skilled maintenance therapy.
The agency will use the statement as part of its Corrective Action Plan, which was ordered by the court on Feb. 1 to remedy noncompliance with the Jimmo settlement. The same court told CMS to implement the plan by Sept. 4.
According to the Center for Medicare Advocacy, which is a coalition of stakeholders advocating for implementation of the settlement, the CMS statement reads:
“CMS reminds the Medicare community of the Jimmo Settlement Agreement (January 2014), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo settlement required manual revisions to restate a ‘maintenance coverage standard’ for both skilled nursing and therapy services under these benefits:
“Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.
“Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (‘skilled care’) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient's current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.” 
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