Friday, August 19, 2016

Courts Order CMS to Provide Better Education on Maintenance Therapy and Nursing

Dan Ciolek

Earlier this week, the Federal Court that oversees the Jimmo v. Burwell “improvement Standard” case ordered the Centers for Medicare and Medicaid Services (CMS) to comply with the provisions of the 2013 Jimmo v. Sebilius settlement agreement. CMS was directed to remedy its educational campaign and submit a proposed corrective action within 45 days. Pursuant to the earlier Settlement Agreement, the parties agreed to a “maintenance coverage standard,” which provides that skilled nursing and therapy services would be covered where such skilled services are necessary to maintain the patient's current condition or prevent/slow further deterioration.

In the current case, Jimmo and other plaintiffs – including the Center for Medicare Advocacy – submitted evidence and declarations from individuals and organizations, including the American Health Care Association, demonstrating that CMS has not made a good faith effort to educate beneficiaries, providers and review contractors about the appropriate coverage guidelines for maintenance care. This is limiting beneficiary access. In the Opinion and Order, the Court held “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.”

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