Tuesday, December 10, 2013

Jimmo v. Sebelius Manual Updates

CMS has issued updates to its manual to implement the Jimmo agreement for SNFs, IRFs, home health and outpatient coverages. Transmittal 175 to Publication 100-02 Medicare Benefit Policy (issued December 6, 2013) goes into effect January 7, 2014.

 Here is an overview of the changes:

In accordance with the Jimmo v. Sebelius Settlement Agreement, the Centers for Medicare & Medicaid Services (CMS) has agreed to issue revised portions of the relevant chapters of the program manual used by Medicare contractors, in order to clarify that coverage of skilled nursing and skilled therapy services "…does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care." Skilled care may be necessary to improve a patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration of the patient’s condition.

One of the major changes includes the end of the application of the "'Improvement Standard'... in determining Medicare coverage for maintenance claims that require skilled care."

The Medicare Learning Network (MLN) MLN Matters #8458 provides more details about the changes.

Thanks to Amos Goodall for sending the link!



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